pediatric nursing

4. 20.000 child yearly
Die due to Injury
For each
child dies
Additional 40 are admitted
1120 are treated in ER
& released home
Fifty thousand
of these surviving children
will suffer
permanent disability

5. 1.6 million
head injuries
every year
In USA
> 250.000
Admitted to
Hospital
60.000
Deaths
70.000 –
90.000
Permanent
Neurological

6. In USA
According to the national head and
spinal cord survey in USA, direct costs of
diagnosis, treatment and rehabilitation and
the direct costs of society from lost
productivity, total more than five billion
dollars. This doesn’t include such
psychological and emotional issues as pain,
suffering, effect on family and significant
others or disability. Therefore, the total
costs are probably enormous.

7. 121 Deaths of
Motor Vehicle at 5
years or more
In Egypt
334 Deaths of
Motor Vehicle
at 10 years or
more
10% of orthopedic
patients (5-15 yrs)
hospitalized due to
trauma
1998
2000

8. 55.33% of
Orthopedic
Patients aged 6-12
Yrs
In Alexandria
63.3% of Orthopedic
Patients in Sporting
Student Hospital are
school age.
2000

9. Common Causes
of Head Injury
Motor Vehicle
Child Abuse
Falls
In Early
Childhood

10. Common Causes
of Head Injury
Motor Vehicle
Personal Fighting
Riding Bicycle
In Late
Childhood
Falls

11. Unique Pediatric Parameters and significance
to trauma Care:
Variable Significant
Cerebral edema developsrapidly
Large volume of blood in head
Flexion/extension injuries occur
Poor muscular support in neck
Higher center of gravity
Increased head to body ratio

12. Unique Pediatric Parameters and significance
to trauma Care:
Variable Significant
Increasethe risk of brain injury
Thinner cranial bones.
Fractures are common
Bones are soft and pliable

13. Primary Skull fracture
Contusions
Hematomas
Types of head injury:
Concussion
Secondary Hypoxia
Decreased CBF
Increased ICP
Hypotension

14. Signs & Symptoms:
Amnesia about event
Nausea
Vomiting
Headache
Conscious
Loss consciousness
(5-10 min)
Mild
Moderate
Unconsciousness
more than 10 min
Signs of Increased ICP
Altered Vital Signs
Severe

15. Assessment of
Head Injured Patient
Primary
Trauma
Survey
A
Airway
Stabilized Cervical
Spine
B Breathing
C Circulation
D Disability
(LOC, Pupils)

16. Assessment of
Head Injured Patient
Secondary
Trauma
Survey
Glascow
Coma
Scale
Glascow
Coma
Scale
Eye Opening
Verbal Response
Motor Response
4 Spontaneously
3 To Speech
2 To Pain
1 None
5 Orientation
4 Sentences
3 Words
2 Sounds
1 None
6 Obeys
Commands
5 Localizing
4 Normal
Flexion
3 Abnormal
Flexion
2 Extension
1 None

18. Management of Head Trauma
Prehospital
Phase
Initial
Hospital
Management
Continuing
Management
In
ICU

19. Prehospital Phase:
Goals
Maintain a Patent Airway
Fluid Resuscitation
Immobilize the Cervical
Region
Assess the Level of
consciousness
Maintain adequate BP

20. History – Taking in Head Injury
Mechanism of injury
Time elapsed
Period of loss consciousness
Any pre / post – traumatic amnesia
Condition since injury , such as nausea,
vomiting, confusion, visual disturbance,
lethargy or dizziness

21. Indications for Hospital Admission
Decreased consciousness
Neurological deficit
Severe headache and persistent
vomiting
Confusion

22. Initial Hospital Management:
Give Oxygen Concentration
100%
Restore Blood Pressure
& Normal Circulation
Diagnostic Studies
Diagnostic Studies
Physical
Examination C.T.
X Ray
MRI
Neurological
Assessment
S&S of ICP

23. Initial Hospital Management:
If
Patient
with
No Loss of
Consciousness
No
Amnesia
No
Fractures
GSC =15
Can Go Home
With Reliable caregiver
With Written
Instructions

24. Head Injury Advice Sheet
Observing a patient every 2
hours
Ensure he wakes easily and is
orientated when awake .
Ensure the patient is able to
move all limbs

25. Head Injury Advice Sheet
You should return to hospital if any of the
following occur:
Confusion, excessive sleeping; difficulty
in rowzing patient
Severe headache, double vision
Limb weakness, convulsions or “passing
out”
Discharge of blood/ fluid from nose / ears

26. Initial Hospital Management:
If
Patient
with
Loss of
Consciousness
Amnesia
Focal Neurologic
Examination
GSC = < 13
Immediate CT Scan
Admitted to ICU

27. Continuous Management in ICU:
Physiologic& ICP monitoring
Aggressive Fluid Resuscitation
Blood Pressure
Mechanical Ventilation
Continuous Pulse Oximetery

28. Continuous Management in ICU:
Endotracheal Suction
Care of Fever
Prevention of Jugular Venous
Outflow Obstruction
Change Position
Seizure prophylaxis

29. Continuous Management in ICU:
Management of Established
Intracranial Hypertension
Elevation of the
Head of Bed
to 30
)
Monitor ICP
Use Hyperosmotic
Agent

30. Keep the head and
neck in neutral
alignment.
•Head flexion, extension or rotation.
•Lateral neck flexion.
•Pushing up the patient in bed.
•Extreme hip flexion.
Avoid
Careful monitoring
of appropriate
physiologic
variables.

31. Proper
positioning is important
in helping to lower
intracrainal
hypertension, improving
the level of
consciousness

32. Other Management in ICU:
Electrolyte Derangements
Nutritional Support

34.  Disabled children should be adapted to
life by facilitating the process of
rehabilitation planning through
appropriate resource programs.
 Management of children with severe
head injury is complex and requires a
coordinated, comprehensive ,and
multidisciplinary approach.
 Considering the enormous costs to
society , we need to invest greater
resources in the prevention of this
pandemic