Viji child health nursing

4.  Accidents and paediatric emergencies are common threat for the
survival of children . Medical emergencies in paediatric practice
constitute a sizeable segment of illness among infants and children.
Since emergencies do not often permit leisurely consultations with
specialists. History taking may be difficult and examination of children
also. So, every medical personnel must possess a sound practical
knowledge of efficiently handling these emergencies, syndromes.

5.  Cardiac arrest may occur without warning or as a terminal event in
chronic disease processes.
 It may manifest in one of three ways.
1. Ventricular stanstill (asystole)
2. Ventricular fibrillation.
3. Cardio vascular collapse.

6. 1.Pallor
2.Verypoororalmostimpreceptiblepulse
3.Unrecordablebloodpressure.
4.Cessation of respiration.
5.Ineffectivecardiacaction.
The diagnosis is confirmed by palpation of the carotid and femoral
pulses.
ECG

7.  If the cardiac pulse is absent and no heart beat is heard, the use of a
defibrillator And CPR.
 The patient must be put on a board or on the floor with the head
lowered.
 The most important treatment is to maintain a clear air-way by tilting the
head backward, cleaning the upper air passages.
 Administrations of oxygen with 100%.

8. Cardiac temponade results from rapid accumulation of fluid within the
Pericardium there by raising the intra pericardial pressure to the point
where the venous flow and the diastolic filling of the heart are impeded. It
occurs in sudden hemorrhage into the pericardium.

10. Clinical feature
 Distended jugular veins
 Paradoxical pulse
 Peripheral oedema
 Tachycardia
 Hepatomegally
 Shock.
 Diagnosis
 Muffled heart sounds.
 Enlarged area of cardiac
dullness and the apex beat not
being palpable.
 Fluoroscopy may demonstrate
the absence of pulsation of
cardiac border.

11. Treatment
1. Immediate relief is given by evacuation of the fluid.
2. Pericardiocentesis is done through one of the following sites
depending on the individual situation.

12. Drowning is one of the important causes of accidental death among
children. Asphyxia with a matter of 1-2 minutes after complete
submersion and cardiac arrest occurs in the next 2-5 minutes.

13. Clinical features
 Abdomen distension
 Reflex apneaHypoxia, hypercapnia, & acidosis
 Cardiac arrhythmias, hypotension and renal tubular necrosis
 HyponatrimiaVomiting and aspiration
 Terminal apnea
 More inhalation of water
 Pulmonary & cerebral oedema

14. Management
 The immediate treatment is to clear the air way and start mouth to
mouth breathing, closed cardiac message and oxygen.
 The child should be moved to the hospital as quickly as possible
 Back blow is done
.

15. Acute respiratory failure is a life threatening emergency which requires
prompt treatment in some kind of situation when hypoxia is present along
with hyper capnoea. A low partial pressure of oxygen in arterial blood
PaO, 50 mm of Hg with or without elevated CO, in arterial blood PaCO,
50 mm of Hg, is as respiratory failure.

16. ETIOLOGY
CNS
 Head injury
 Guillain Barre syndrome
 Polio myelitis
 Myasthenia gravis.
Cardiovascular system
 Congenital heart disease
 Congestive heart failure.
Respiratory system
 Asthma
 Emphysema
 Foreign body
 Croup- Pneumothorax
 Pleural effusion
 Pulmonary oedema
 Chest wall –Traumna
 Poisoning:- Narcotic poisioning

17. Treatment
1. The oxygen administration (1-4 lit/minute).
2. Assisted ventilation.
3. Aminophylline for relief from branchospasm.
4. Antibiotics, steroids, digitals and potassium chloride.
5. Endotracheal tube intubation if condition is not improved.

18. Disorders of consciousness (alteration of sensorium) may range from
stupor to coma. Stupor is partial disturbance of consciousness from
which the patient can be aroused, whereas coma is a complete
obliteration of consciousness from which the patient cannot be aroused
by even painful stimuli.

19. ETIOLOGY
intracranial causes
 Trauma
 Raised intracranial pressure or
tension
 Meningitis
 Intracranial tumors
 Degenerative disease
 Encephalitis
Extra cranial causes:
 Shock
 Diabetic coma
 Hepatic coma
 Uremia
 Hypoglycemia
 Electrolytic imbalance
 Poisons
 Septicemia
 Hyper pyrexia
 Anaphylaxis

20.  History of the child from parents.
 Complete physical examination including vital signs, neurological
defects like (hemiplegia, cranial nerve paralysis)
 Laboratory investigation.
 Urine examination for sugar and acetone.
 Lumbar puncture.
 X-ray of skull and chest.

21. Emergency treatment
 Maintain the airway.
 Tracheostomy.
 Administration of oxygen.
Supportive treatment :
 Administration of I.V. fluids.
 Nutrition through nasal tube feeding
 Frequently changes the position
 Catheterization for bladder care

22. Shock is a syndrome which is characterized by a traid of findings are
1. Hypotension
2. Break of effective tissue perfusion.
3. Profound protrusion producing wide-spread systematic effect.

24. Types Etiology Clinical features Diagnosis management
Hypovolemic
shock:
The most
common type
of shock. It is
characterized
by decreased
intravascular
volume.it
occurs when
there is a
reduction in
intravascular
volume of15%
to 25%.
• Haemorrhage
• Burns
• Dehydration
• Intestinal
obstruction
• Infection like
peritonitis.
• Decreased
blood
pressure
• Low central
venous
pressure
• Tachycardi
a
• Whole blood
is the ideal
treatment for
shock due to
haemorrhage
Plasma loss is
combated by
plasma if
available.
Isotonic fluids
are indicated
for all the type
of
dehydration.

25. Types Etiology Clinical features Diagnosis Management
Frequently check
the vital signs. Foot
end elevation for
improvement of
blood circulation.
CARDIOGENIC
SHOCK
Occurs when the
heart's ability to
contract and to
pumping blood is
impaired and the
supply of oxygen is
inadequate for the
heart and tissues.
•Cardiac
temponade due to
pericardial
effusion.
•Cardiac
arrhythmias
•Myocarditis
•Cardiac
arrhythmias
•Electrolyte
disturbance like
acidosis,
hypocalcaemia
•Congestive heart
failure.
•Increased venous
pressure.
•Increased venous
resistance.
•Tachypnoea,
cyanosis, crackles
•Hypernatremia,
•Decreased urine
output.
•Skin will be
pallor,cool,
clammy.
•Decreased bowel
sounds,
nausea/vomiting.
•Cardiac sound
not heard during
physical
examination.
•Increased blood
glucose level
•Electro
cardiogram
•Chest X-ray.
•Removal of
pericardial fluid.
•In early stages of
shock,supplement
al oxygen is given
by nasal cannula
at arate of 2 to 6
L/mint to achieve
oxygen saturation.
•Controlling heart
rate.Providing
selective fluid
support.

26. Types Etiology Clinical features Diagnosis Management
•If the patient
experiences
chestpain,
morphine
sulphate is given
intravenously for
pain relief.
NEUROGENIC
SHOCK OR
PSYCHOGENIC
SHOCK
It is a
hemodynamic
phenomenon that
occurs after a
spinal cord injury
at the fifth thoracic
vertebra or above.
•Spinal cord injury
•Spinal anaesthesia
•Pain
•Drugs-especially
vasodilators.
•Tachycardia
•Tremor
•Pallor
•Hypotension
•Decreased
cerebral blood
flow.
• Loss of reflex
activity with bowel
and bladder
function.
•Restoring
sympathetic tone
either through the
stabilization of a
spinal or injury or
in the instance of
spinal anaesthesia.
•Positioning the
patient properly.
•If hypoglycaemia
(insulin shock) is
the cause, glucose
rapidly
administered.

27. Types Etiology Clinical features Diagnosis Management
SEPTIC OR
BACTERIMIC
SHOCK
It is a systemic
inflammatory
response to a
documented or
suspected
infection.
•Gram negative
septicaemia
•Meningitis
•Peritonitis
•Other infection.
Early
•Increasing and
decreasing of
body temperature
•Tachycardia
•Hypotension.
Late
•Increased PCO,
level and
decreased PO,
level.
•Respiratory
acidosis.
•Pulmonary
hypertension with
crackles sounds.
•Decreased urine
output.
Skin hemorrhages.
•Hepato
splenomegaly.
•Blood
examination for
WBC count.
•Platelet count.
•Positive blood
culture.
•Urine
examination for:
•Specific gravity
•Urine sodium
level decreased.
•Broad spectrum
antibiotics are
started until
culture and
sensitivity reports
arereceived.
•Cephalosporin
agent plus an
amino glycosides
may be prescribed
initially.
•Nutritional
supplementation
should be initiated
within the first 24
hours of the onset
of shock.

28. Types Etiology Clinical features Diagnosis Management
ANAPHYLACTIC
SHOCK
It occurs as a result
of an acute allergic
reaction from
exposure to a
substance to which
the child has been
sensitized. The
substance are
drugs, chemical,
vaccine, food or
insect venom
•Urticaria
•Respiratory
distress
•Bronchospasm
•Circulatory
collapse
•Chest pain
•Swelling of lips
and tongue
•Shortness of
breath
•Edema of the
larynx and
epiglottis
•Wheezing,
Rhinitis, Stridor
•Mental confusion
•Nausea, vomitting,
diarrhoea etc.
•Removing the
causative antigen.
•Epinephrine is
given for its
vasoconstrictive
action.
•Diphenyl
hydramine is
administered to
reverse the effects
of histamine,
•Aminophylline is
given to reverse
histamine induced
bronchospasm.
•If cardiac arrest
have occurred,
cardiopulmonary
resuscitation is
performed.
•Endotracheal
intubation

29.  Haemorrhage is a term applied to bleeding or a flow of blood, especially if it is
veryprofuse. The haemorrhage may be external or internal. The latter form of
haemorrhageis often serious and requires prompt diagnosis and treatment.

30. 1. Gastro intestinal system
 Hematemesis
 Rectal bleeding
2.Respiratory System
 Epistaxis
 Hemoptysis
 Hemothorax
3) Renal System
 Hematuria

31.  When gross haemorrhage
occurs from areas which are
obvious, a tourniquetmay help
to control the hemorrhage. The
torniquet is loosened every 15-
20minutes for one or two
minutes and re-applied till
routine care can be instituted.
 Restoration of blood volume
 Supportive therapy includes
oxygen, suction, gastric lavage
and treatment ofcardiac arrest
and temponade if hemorrhage
is associated with trauma.

32.  Infancy is the oral phase, when infants explore everything by putting
them in the mouth. If small objects are put in the mouth, they may get
aspirated.
 Toddlers often aspirate foreign bodies such as peanut, almond,
groundnut seeds, grains and pulses. Occasionally, small metallic coins
may also be inhaled though, more often, these are swallowed.
 There is a sudden paroxysm of cough with congestion of the face and
almost a state of suffocation. If the foreign body fails to be coughed out,
it may cause partial or complete obstruction of a main bronchus.

33.  It is from the history of a sudden paroxysm of violent, clinical findings of
pneumonia, collapse, emphysema, etc. bronchoscopy and radiology
(provided if it is a metallic foreign body).

34. Precautions-
 The care should be taken not to leave any small objects in infants hand
and within their reach.
 Toys should not have any small removable parts. Infants should never
be fed solid foods which are difficult for them to chew, such as
groundnuts.
 Management is aimed at removing the foreign body (in most cases by
bronchoscopy) and administration of appropriate antibiotics in care of
infection.

35.  The growth, characteristic of the normal child such as increased activity and oral
exploration of objects in early life, naturally leads to such accidents.
 Transferring poison from its original container, careless misplacement from the usual
place of storage and lack of storage space in low socio-economic groups.

36. 1. Kerosene oil poisoning
2. Ddt poisoning
3. Datura poisoning
4. Lead poisoning
5. Mercury poisoning
6. Chronic mercury poisoning

37. General
 Pyrexia
 Hypothermia in morphine, Phosphorus
etc.
 Excessive salivation
 Organophosphorus-Odour in breath
Kerosene
 Pallor-Lead, Benzene etc.
Cardiovascular systems
 Tachycardia-Atropine, Digitalis etc.
 Bradycardia-Morphine, Digitalis
 Hypertension
 Hypotension-Sedatives, Largectil etc.

38. Respiratory system
 Tachycardia-Atropine, carbon-
monoxide
 Bradypnoea-Morphine.
Centeral Nervous system
 Convulsion-Antihistamine
 Neck rigidity spasm-Lead, magnesium
 Hyporeflexia.-Lead, magnesium

39. The diagnosis of poisoning may not often be obvious and should be suspected in
obscurely in patients.
 By the physical examination.
 Laboratory examination.

40. 1. Emetics- Vomiting is induced by tickling the back of the throat or by the use of
emetics such as large drinks of salt water or by syrupP ipecac 9-15 ml repeated
after 15 minutes. Apomorphine hydrochloride 0.l mg/kg 1.V. or subcutaneously may
be used to induce vomitting.
2. Castric lavage-For the cleaning of the gastrointestinal tract and administration of
antidotes. The fluid that are usetul in gastric lavage are Warm tap water. One % salt
solution. Activated charcol 90 gm in 400 ml of water.
3. Absorption Non-specific absorbants like activated charcol powder are very effective
and may be used after gastric lavage. 10-15 gm administered for each gm poison.
4. Symptomatic and supportive therapy
 Keep the patient warm.
 Administration of blood and isotonic fluids.
 Suctioning of the respiratory tract
 Antibiotics for prevention of complications

41.  Traffic accidents or vehicle accidents are major cause of mortality today. In
metropolitan cities, these accidents are increasing day by days. As the road traffic
increases, risk of accidents is also increased. Road traffic accident are more common
till school age group.

42.  Advancement of play materials and riding methods like - cycles and small petrol bikes
.
 Negligence of parents.
 Lack of supervision.
 Playing by children in colonies, streets and on roads.
 Allowing the bicycles and tricycles to ride by the children at road sides.
 Negligence of traffic rules
 Lack of first aid facilities vehicles.

43.  Children must not be allowed to play in streets.
 Children should be taught how to safely cross the road as soon as they are old
enough to understand.
 They should be careful not to be run over by a reversing car.
 They must not be allowed to stand in a car when in motion and never left alone in a
care unless it has been ensured that the keys are not in.
 Children using bicycles and tricycles must be cautioned against ditches and manholes
in the drive which may cause accidents.Implementation of Rules
 Traffic rules, such as compulsory wearing of crash helmets.
 Restriction of the speed to recommended limits.

44.  Checking of blood alcohol level of drivers that Regular checking of
vehicles.
 Seat belts should be also made compulsory.
 Regular caution needs to be exercised in issuing driving licences.
 A driving licence should bear the blood group of the owner.
 Children must not travel on the front seat of the car.
 Condition of roads must be up to the mark.
 Every crossing and every vehicles must have first aid facilities and
every driver must be familiar with first-aid administration before being
issued a license.

45.  Pediatric emergency medicine is a medical subspecialty of both
pediatrics and emergency medicine. It involves the care of
undifferentiated, unscheduled children with acute illnesses or injuries
that require immediate medical attention.

47.  Aim: Systematic review of knowledge translation studies focused on
paediatric emergency care to describe and assess the interventions
used in emergency department settings.
 Methods: Electronic databases were searched for knowledge
translation studies conducted in the emergency department that
included the care of children. Two researchers independently reviewed
the studies.
 Results: From 1305 publications identified, 15 studies of varied design
were included. Four were cluster-controlled trials, two patient-level
randomised controlled trials, two interrupted time series, one
descriptive study and six before and after intervention studies.
Knowledge translation interventions were predominantly aimed at the
treating clinician, with some targeting the organisation.

48.  Studies assessed effectiveness of interventions over 6-12 months in
before and after studies, and 3-28 months in cluster or patient level
controlled trials. Changes in clinical practice were variable, with studies
on single disease and single treatments in a single site showing greater
improvement.

50.  Write an assignment on mercury poisoning

51. BOOK REFERENCE:
 Rimple Sharma,’’Essential Of Paediatric Nursing,’’2ndedition,Jaypeepublication Pg
No:502-504.
 Parul Data ‘’Pediatric Nursing’’ 2ndedition(2009),Jaypee Brothersmedical Publication
Pg No:483-485.
 Ghai, ‘’Essential Pediatrics’’7th Edition(2009),CbsPublisher Pg No:371-374 .
NET REFERENCE:
 https://www.healthline.com/health/paediatric emergency
 https://journals.lww.com/clinorthop/fulltext/2009/05000/update_on_paediatric
emegencies__etiology_and_treatment.5.aspx
 https://www.hopkinsmedicine.org/health/conditions-and- racing