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Preventable Trauma :football::ambulance: (Concussion (Drowning :swimmer:…
Preventable Trauma :football::ambulance:
Covers head injuries
& a few ways :boy::skin-tone-2:'s get hurt an how to prevent :octagonal_sign:
2 populations of kids that get into trouble
Too young to know what they're doing < 3y :baby::skin-tone-3:
Too drunk :beer: to remember: Adolescents falling from a roof:boy::skin-tone-2:
Know what to do about it when you see
Be able to distinguish abuse from accident (hard)
Kids have disproportionally large heads (head hits ground when thrown from MVA :car:)
Preventing Head trauma
Car Safety
Rear facing car seats
ages 0-2 :baby_bottle:
Back seat only
steatbelted down
Booster seat
bridge btw child-adulthood (min. 4'9" tall)
usually 8-12yo :boy::skin-tone-2:
basically
older adolescents don't use booster seats/ but should
Seatbelts
Helmets
anytime playing sports :football:
sports w/o helmets have higher risk :soccer::rugby_football:
head trauma can still happen (helmet to helmet)
Trampoline care
Nets, water, soft landing nearby is ineffectual
Trick question!
Get rid of trampolines.
Kill that joy, kill it!
Head Trauma
Subdural Hematoma
Cerebral contusion
Path:
Deceleration injury
resulting in loss of consciousness
Sports: :football: Helmet to helmet
Coo injury Brain keeps moving forward to hit the skull
contra-Coo injury: brain sloshes back to the opp wall
Dx: CT :radioactive_sign: Punctate hemorrhages
Usually intraparynchemal
Tx: Reduce ICP, evacuate hematoma
Epidural Hematoma
Path:
Strike to head
Ball sports :soccer::football:
Skiing w/o helmet :skier:
Syndrome:
"Walk, Talk, then Die"
LO consciousness
wakes up
Bleeding hematoma expands = coma/death :bed::skull_and_crossbones:
middle meningeal artery
Dx: CT :radioactive_sign: Lens shaped Hematoma
Path:
Significant Trauma
:explode:
Brain comes off skull stretches bridging veins
Pedestrian strike: :police_car::walking::skin-tone-2:
young short kids get hit in shoulder and fly
MVA
:boy: thrown from car :car:
Shaken Baby:baby::skin-tone-2: Syndrome
Abuse
Pt: Trauma puts pt into coma :bed:, and they stay in a coma
Dx: CT :radioactive_sign: Crescent shaped :waxing_crescent_moon: hematoma
Concussion
Path: Head trauma w/o bleed
Pt: Sports Injury
helmet to helmet :football:
Taikwando tournament :martial_arts_uniform:
"flying crane kick to the head"
:pencil2:We don't grade concussions (anymore)
But since Step can't throw curve balls, vignette must be clear… grade concussions (mild/severe)
Mild
no focal neuro deficit (FND)
brief Loss of consciousnes ( < 60s)
no HA
or
HA is improving
no Amnesia
won't remember the period after the collision during LOC
Dx:
CT
Tx: Go home :house_with_garden:
f/u: Return to play in stepwise fashion
"Can my kid return to play?
- NO!
Pt gets normal sleep
returns to school
Introduce scrimmages
Eventually return to play
:warning:Anytime there is a HA or worsening s/s, where kid can't perform the task at hand,
step down and start over
Severe
Any one of these is :red_flag:
:check:FND
LOC (> 60s)
:check:HA
or
worsening HA (px, nausea, vom)
:check:Retrograde
or
Anterograde Amnesia
Dx:
CT
for bleed r/o
(remember a concussion by definition has no bleed = negative CT)
Tx: Admit after CT is negative
you have concern for neuro checks
Drowning :swimmer::skin-tone-4:
Burns :fire:(peds)
Gun Safety :gun:
Chemical safety :biohazard_sign:
Keep chem up high out of reach
Keep chemicals locked in cabinet
Guns are like trampolines…how? Get rid of them, they kill kids :boy::skin-tone-2:
Far more likely to have accidental discharge than stopping home invasion
Child likely to use gun on themselves or another child, or family member
If Mom/Dad doesn't want to give up guns?
Keep up high, out of reach
Keep them locked :lock: :gun:
gun safe, or gun locks
Keep weapon separate from ammo
Parkland formula
(%body surf area burned ) x 4 x (kg body weight)
2º or 3º burns only
Kids: have bigger heads :baby::skin-tone-2:
Rule of 9's changes (
burns lecture
)
front & back of head = 9 pts
front & back of torso/ab = 9 pts ea (18 for chest & ab 1 side)
each arm front & back combined = 9 pts
4 compartments of the leg (L/R/A/P) only count for three 9's (27pts total)
genitals = 1pt
50% of parkland fluid given in 1st 8hr
50% of parkland fluid given in next 16hr
Pt:
A bad swimmer
too young :baby::skin-tone-2:
too drunk :beer:
takes a teaspoon :spoon: to drown, any water source is enough to drown
Look for:
Tubs :bathtub:
Pools :water_polo::skin-tone-2:
Buckets
Prevention:
Limit acess
gates, fences
rarely does your child drown in your pool
Provide supervision
Lifeguards :beach_with_umbrella:
bottom line: don't trust your kids around water,
watch them
same for bathing babies :baby::skin-tone-2::bathtub:
Flotation:
Floaties
floaties keep arms on top and head can fall into :ocean:
Use Life jackets
: on water, on boat, near water
Miscellaneous
Salt water drowning worse than fresh water b/c of
pulmonary edema
Cold water drowning better
than warm water drowning
lower metabolic demand
hypoxemic longer