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Accidents and Poisoning - Coggle Diagram

- - - - OTC
      - Prescription
      - Illicit drugs
    - - Cleaning and gardening products
      - Cosmetics and aromatic oils
      - Poisoning plants
      - Glue
      - Pesticides
      - Batteries
  - - - Reduced conciousness
      - Metabolic acidosis - high anion gap
      - Arrhythmia
      - GI upset
      - Seizures
      - Behavioural changes
  - - - B blocker
      - Antidepressants
      - Opiates
      - Iron
    - - Cocaine
      - Amphetamines
    - - Iron poisoning
      - Alcohol
      - Insulin
    - - Salicylates
    - - Beta blockers
      - Digoxin
    - - Tricyclic AD
      - Organophosphates
    - - Salicylates
      - Iron
      - Ethanol
      - Methanol
      - Ethylene glycol
  - - - Type
      - Time
      - Amount
      - Weight of child
      - Is ingestion harmful
      - Beware of inaccurate dose report
      - Mixed or undetermined ingestion
      - Look at original bottle / pack
    - - Antidotes
      - Activated charcoal
      - Gastric lavage
      - Whole bowel irrigation
  - - - Flumazenil
    - - Deferoxamine
    - - Nalaxone
    - - N-acetylcystine
    - - Glucagon / Adrenaline
    - - Fab antibodies
  - - - Large bore oorogastric tube with normal saline irrigation
      - Depressed conscious state - EET for airway protection
      - Most effective within 1hr of ingestion
    - - Hydrocarbons
      - Acids
      - Alkalis
    - - Aspiration pneumonitis
  - - - Heavy metal poisoning
      - Acid / alkalu
      - Endoscopy required
      - Alcohol
    - - Promotes reabsorption from circulation into bowel
      - Interrupts entero-hepatic circulation
    - - Very unpalatable => give via NG / lavage tube (25-50g)
      - Severe lung damage if aspirated
      - Patient must be conscious or airway protected
      - Window of opportunity; 1 hour (↑ with salicylates)
- - - - Asymptomatic
      - Nausea and vomiting
    - - Right subcostal pain +/- liver decompensation
      - Suggestive of hepatic necrosis
  - - - Paracetamol level
      - LFT
      - INR
- - - - Nausea, vomiting, abdominal pain
      - Hypoglycaemia
      - Ataxia, lethargy, coma, convulsions
      - Respiratory depression
      - Hypothermia
      - Hypokalaemia, metabolic acidosis
    - - Observe
      - Treatment if symptomatic
      - Charcoal is of no benefit
      - Treat hypoglycaemia
      - Blood ethanol
      - Temperature regulation
- - - - Initial (20min) : GIT
      - Latent (6-24hrs)
        
        Tachycardia
        
        Hypotension
        
        Shock
        
        Metabolic acidosis
      - Delayed symptoms (12-48hrs): Hepatic failure
  - - - Consider if >90micromol/L
      - 60-90micromol/L and symptomatic or tablets on AXR
      - Worsening symptoms, reduced GCS, severe acidosis (pH<7.1), shock --- IMMEDIATELY
- - - - Anxiety, sweating, fever, tachycardia, hyperventilation
      - Respiratory Alkalosis
      - Compensatory alkaline urine with loss of HCO3-, K+
    - - ↓ K+ (and paradoxic aciduria)
    - - dehydration
      - acidosis predominates
      - pulmonary oedema
      - respiratory failure
- - - - Non mobile
      - Soft parts of body
      - CLuster of bruises
      - Bruises with petechia
      - Multiple bruises of uniform shape
      - Imprint of implement
  - - - Tenderness
      - Swelling
      - DEformity
      - Restricted use
    - - Hx inconsistent with mechanism of injury
      - Underlying condition predisposing to recurrent fractures
      - Developmental milestones of child
    - - X ray
      - Rest
      - Immobilise and protect
      - Analgesia
      - Physio
      - Perforated - Abx / tetanus
      - Concern of abuse
        
        Skeletal survery - gold standard
        Repeat 11-14 days
        
        Radionuclide bone scan
        Idenifies hot spots
        May miss metaphyseal fractures
    - - 11-55% of abused children have fractures
      - 80% under 18 months
      - Many abusive fractures not clinically obvious
      - May not be accompanied by bruising
    - - In abscence of organic bone disease
      - Rib fracture
      - Femoral fracture in non ambulatory child
      - Metaphyseal fracture in young children
      - Spiral / oblique fracture of shaft of humerus
      - Tibia and fibular in under 18 months
      - Skull fracture
      - Fracture inconsistent for developmental age
  - - - Sudden pull on hand with elbow extended
      - Radial head sublux
    - - Child holds forearm unwilling to move
    - - Reduce by supinating forearm, then flex
      - Immediate recovery
  - - - Most common under 5
      - MAjor source of morbidity and mortality
      - Most commonly cups of tea, bath water
    - - Hot liquids
      - Fire
      - Smoke inhalation
      - Electrical injury
      - Chemical burn
    - - Depth
        
        Superficial
        
        Partial thickness
        Pink
        Mottles
        Blistering
        Painful
        
        Full Thickness
        White
        Charred
        Painless
      - Extent - % of body surface
      - Location
    - - ABC
      - IV access - 2 IVC wide bore
      - IV fluid replacement
        Bolus
        Parkland formula
        Monitor UO
      - ANALGESIA
      - Wound car & plastic review if indicated
  - - - Who what where when
      - Timing of presentation
      - Correlation of hx and exam
    - - DElayed presentation
      - Hx not compatible with injury
      - Changes in hx or complaint
      - Frequent attendance to medical professional
      - Multiple previous injuries
      - Stage of development
  - - - Leading cause of accidental death worldwide
      - 1/5 are children 14 and younger
      - 2% mortality under 4
      - 70% survive if basic life support given at scene
      - Good predictors
        
        Time to 1st gasp under 3 min
        
        Hypothermia
    - - Breath holding
        
        Bradycardia
        
        Hypoxia
        
        Tachycardia
        
        Increased BP
        
        Acidosis
      - Breathing movements
        
        Laryngeal spasm and secondary apnoes
      - Involuntary breathing efforts - cardiac arrest
    - - Life gaurd
      - Swimming safety
      - Supervisions
      - Known epileptics - supervised with bright swimming cap
      - Education
  - - - Heimlich
      - Unconcious - Follow APLS guidlines
  - - - Booster seat