Home accidents are common and can cause injury or death in children. The most frequent accidents include choking, suffocation, drowning, burns, poisoning, and falls. Risk factors include lack of supervision, family stress, overcrowding, and natural curiosities of children. Common injuries involve the head, neck, eyes, and extremities. Treatment depends on the type of accident but may include clearing airways, administering CPR, giving antibiotics and tetanus shots, and watching for complications over time. Maintaining supervision, removing hazards, and learning first aid can help reduce risks of home accidents in children.

1. TOPIC:HOME ACCIDENTS
Group 4

2.  Definition
 Risk factors
 Most common accidents at home
 How to deal with the accidents

3.  WHO defines an accident as an event
independent of human willpower carried by an
external force, acts rapidly and results in bodily
or mental damage or injury.
 Random ,chance and uncontrollable.
 Injury is an intentional/unintentional damage
to the body due to exposure to external agent
which can be thermal ,chemical ,electrical , or
mechanical energy or agent .

4.  Lack of/poor supervision of children
 Family stress like death,chronic illnesses,
homelesness
 Parental carelessness and ignorance
 Living with elderly
 Marital discord
 Overcrowding
 lack of out door play facility
 Unfamiliar environment

5.  They don’t know how to keep themselves safe.
 They have small hands , arms ,legs and feet
that can be caught up in small gaps and holes.
 Their skin is thin and thus easily bruised.
 Natural curiosity, impulsive, hyperactive,
 Drive to test on new master skills.
 Desire for peer approval.

6.  Choking
 Suffocation
 Strangulation
 Drowning
 Burns ans scalds
 Poisoning
 Electrocution
 Envenoming

7. Choking
 Choking is common in young children, who
frequently put things in their mouth and lack
the oromotor skills to avoid choking on them or
inhaling them.
 In addition, their airway diameter is small and
more readily occluded than in adolescents and
adults.
 Food is the most common cause of non-fatal
choking, followed by toys.

8. Infants:
• Lay the infant on your arms or thighs in a
head- down position
• Give five blows to the middle of the back of the
infant with the heel of your hand
• If obstruction persists, turn the infant over and
give five chest thrusts with two fingers on the
lower half of sternum
• If obstruction persists check infants mouth for
any obstruction that can be removed.

10. Children(>1 year):
• Administer back blows to clear airway
obstruction in a choking child.
• Give five blows to the middle of the back of the
child with the heels of the hand with the child
sitting, kneeling or lying.
• If obstruction persists, go behind the child and
pass your hands around the childs body, form a
fist with one hand immediately below the child's
sternum, place the other hand over the fist and
pull upwards into abdomen( Heimlich
manoeuvre). Repeat 5 times

11. • If obstruction persists, check mouth for any
obstruction that can be removed .
• If necessary, repeat the sequence with back
blows

13.  Strangulation
 Children may strangle themselves accidentally
when clothing or bedding gets caught on
furniture particularly young children in cots .
following some incidences the possibility of
strangulation on blind and curtain cords has
been the subject of number of public
information campaigns.

14.  Refers to an event in which a child’s airway is
submerged or immersed in liquid, leading to an
impairment in breathing. Outcome can be fatal or
non fatal[leads to significant neurological damage.
 Babies and toddlers tend to drown in bathtubs,
wells, buckets, swimming pools or garden ponds.
 Older children get into difficulty in canals, lakes
and seas
 If the water is cold, the resulting hypothermia can
have a protective effect and, even in the presence
of fixed dilated pupils, resuscitation should
continue until the child is warm up as recovery
may still be possible

15. MGT
Asses ABCs and check for any injuries that might have been sustained in the
dive
 Give oxygen and ensure adequate oxygenation.
 Remove all wet clothes.
 Use a NGT to remove swallowed water and debris from the
stomach, and when necessary bronchoscopy to remove foreign material,
such as aspirated debris or vomitus plugs, from the airway.
 Warm the child externally if the core temperature is > 32 °C by using
radiant heaters or warmed dry blankets; if the core temperature is < 32
°C, use warmed IV fluid (39 °C) or conduct gastric lavage with warmed
0.9% saline.
 Check for hypoglycemia and electrolyte abnormalities, especially
hyponatraemia which increase the risk of cerebral oedema .
 Give antibiotics for possible infection if there are pulmonary signs

16.  Burns and scalds are relatively common in
children .
 This relates to natural inquisitiveness and lack
of sense of danger in younger children, and
taking risk taking behavior of older children

17.  Heat burns.
 commonest type
 Can be dry or wet
 Severity depends on time of exposure and and
temperature

18.  Electrical Burns:
• Electric currency is converted into heat
• Considered major burns
 Chemical Burns:
• Chemical reactions release heat (exothermia)
• They continue to cause burns even after withdrawal
of the source.

19. Classification of burns
 Depth of burns
 Total surface area of burns

20.  Superficial
 Dermal
further subdivided into ;
• Superficial dermal
• Deep dermal

21. Cont…
 This is the more accurate away of estimating
the severity of burns.
 And its proportional to mortality.
 Two criteria to consider;
 Wallace rule of nine (for adults)
 Luud & Browder rule ( rule of seven) for
children

22.  Very useful in estimating fluid requirement in
the management of burns.
 Considers:
 Head ---------------- 9%
 Trunk ---------------- (18 x2)%
 Upper limbs -------- (9 x 2)%
 Lower limbs --------- ( 18 x 2 )%
 Perineum -------------1%

23.  cont
Considers children’s anatomy
Head ------------- 28%
Trunk --------------( 14 x 2 )%
Upper limb ------- ( 7 x 2 )%
Lower limb --------( 14 x 2 )%
Perineum ---------- 2%

24.  Classification based on % SA
Major burns
TBSA of 15% and above for adults & 10% and
above for children.
Managed as in patient & treated with I/V fluids
Minor burns
This can be managed as out patient with oral
fluids

25.  Local effects:
 Other than epidermal injury, there is too dermal
capillary damage
 They dilate and become permeable
 Causing fluid extravasations and form blisters locally
or edema generally.
 This fluid contains protein (albumin), hence loss to
tissues.
 Fluid movement peaks up 48hrs after burns, there after
reabsorption resumes.
 Fluid lost in to tissue is proportional to area burnt &
capillaries damaged
 So large burns can cause hypovolemia and shock!

26. May be:
 Accidental-common in young children(peak age
is 30 month)
 Due to deliberate self-harm or experimentation
with recreational substances
 Iatrogenic-as a result of drug errors occasionally
made by health professionals
 Intentional-by parents or carers,though this is
rare.
 These poisons maybe ingested, inhaled or in
contact with skin or eyes.

27.  Suspect poisoning in any unexplained illness in a
child that was previously well. Also note that
traditional medicine can also be poisons.
 Dx is based on hx from child or carer, a clinical
exam and results of investigation.i
 Obtain in full details the poisoning agent,
amount, and time of injstion. Also try to identify
exact agent involved and ask to see the container
if possible.
 Check for signs of burns in or around the mouth
or of stridor (upper airway or laryngeal damage)
which suggest ingestion of corrosives.

28.  Note:
• Admit all children who might have taken the
poisons deliberately or were given intentionally
by another child or adult
• Children who have injusted corrosives or
petroluem products should not be sent home
without observation for atleast 6hrs since
corrosivesl can cause eosophageal burns, which
may not be immediately apparent and petroleum
if aspirated coould cause pulmonarary edema
which takes long to develop.

29.  Quick assessment for emergency signs (airway,
breathing, circulation and level of consciousness )
and hypoglycemia which if present and there is low
level of conscienceness, treatsas hypoglycemia.
 Ingested poisons should be identified and have to
immediately be removed from the stomach using the
most appropiate method.
 However, decision of whichever method undertaken
should weigh more benefit than risks associated.
 Note: Decontamination is most effective within 1hr
of poisoning unless the poison delays gastric
emptying meaning it has to be done as soon as
possible.

30.  Petroluem related poisons( kerosene, petrol-
based products,most pesticides) and if childs
mouth is burnt,do not induce vomiting but give
water or if available milk orally then call an
anaesthetist to asses the airway.
 If child has taken other poisons, you couldi
induce vomiting but dont use salt as it can be
fetal.
 Give activated charcoal throughmouth or
nasogastric tube if available and if not
available, induce vomiting (ipecCuanha 10ml
for 6months- 2yrs and 15ml for >2 years) only if
child is conscious

32.  Undertake this only if staff is experienced, ingestion lessthan
an hour and is life threatening and do not perform this it the
poison is corosive or a petroleum derivatibe.
 Procedure
• Make sure suction apparatus are ready in case the child
vomits.ace child in left lateral head-down position.
• Measure lengthbof tube to be inserted
• Pass a 24-28 french gauge tube theough the mouth into
stomach.( Asmaller nasogastric tubes are insufficient to let
particles such as tablets pass).
• Ensure tube is in stomach then perform a lavage with
10ml/kg of normal saline(0.9%).Amount of lavage fluid
returned should approximate amount of fluid given.
• Lavage should continue untill recovered lavage solution is
clear of particulate matter.

33.  Note::a tracheal intubation by an anaesthetist may
be requiredto reduce the risk of aaspiration.
 A specific antidote can also be given if at all
indicated
 Give general care
 Keep child in observation for 4-24hrs depending on
poison swallowed.
 Keep unconscious children in the recovery position.
 Consider transfering child to next level of referal
hospital only when appropriate and when it can be
done safely i.e if the child is unconscious, has burns
to mouth and throat, in severe respiratory distress, is
cyanosed or in the heart failure.

34. • An unprotected airway in an unconscious
child. Only whenairway has been protected by
intubation with an inflated tube by the
anaesthetist
• Ingestion of corrosives or petroleum products

35.  Skin contamination
• Remove all clothing and personal effectsand thouroughly
clean exposed areas with copious amounts of tepid water.
• Use soap and water for oily substances.
• Staff should wear protective gear to prevent secondary
contamination.
• Eye contamination
• Rince the eye for 10-15 mins with clean running water or
normql saline.e of anaesthetic eye drops assist
irrigation.
• Evert eyelids to ensure all surfaces are rinsed
• The child shoild be seen urgently by an
ophthalmologist.

36.  Remove child from source of exposure.
 Urgently call for helpAdminister
supplememtart oxygen if child has respiratory
distress, i.esis or oxygen saturation <
90%.lation of irritant gases may cause swelling
and upper aireay obstruction,bronchospasm
and delayed pneumonitis.
 Therefore, intubation , broncodilatorsand
ventilatory support may be required.

37. agent Clinical
symptoms
mechanism management
paracetamol Early;
Abdominal pain ,
vomiting
Later(12h to24h)
Liver failure
Initial gastric
irritation
Toxic metabolite
produced by
saturation of liver
metabolism
Risk assessed by
measuring plasma
paracetamol
concentration
Treat with iv
acetylcysteine
Button batteries Abdominal pain
Gut perforation
and stricture
formation
Leakage ;
corrosion of gut
wall due to
electrical circuit
production
X-ray of chest and
abdomen to confirm
ingestion and identify
position
•Endoscopic removal
is recommended if in
the esophagus

38. Carbon monoxide •Early;
•Headache , nausea
•Later
•Confusion
,drowsiness leading
to coma
Binds to haemoglobin
causing tissue
hypoxia
High -flow oxygen to
dissociation of
carbonmonoxide
Alcohol Hypoglycemia
Coma
Respiratory failure
Direct inhibitory
effect on glycolysis in
the liver and
neurotransmission in
brain
Monitor blood glucose
correct if necessary . su
ventilation if required
Blood alcohol level ma
to predict severity
Hydrocarbon(e.g
paraffin,
kerosene)
Pneumonitis coma Low viscosity and
high volatility makes
aspiration easy ,
resulting in direct
lung toxicity
No specific treatment-
supportive treatment o
Organophosphor
ous pesticides
Cholinergic effects
Salivation,lacrimatio
n,urination,diarrhoe
a and vomiting,
Inhibition of
acetylcholinesterase
resulting in
Supportive care
Atropine(often in large
as an anticholinergic a

39. of effect Heart rate and
blood pressure
Respiratory
rate
temperature pupils sweating
holinergic
icyclic
pressant
histamine
increased No effect increased dilated reduced
s (e.g.
hine
ne )
reduced reduced reduced constricted Reduced
athomim
caine,am
amines
increased increased increased dilated Increased
ve-
tic(e.g.
nvulsant
diazepin
Reduced reduced reduced No effect Reduced

40.  Asses ABCs and ensure their integrity especially
forchildren with with severe hypoxia, facial or oral
burns, loss of consciousness or inability to protect their
airway or respiratory distress.Asses
 traumatic injuries i.e pneumothorax, peritonitis or
pelvic fractures.n
 Begin normal saline/ ringers lactate fluid resustation,
and titrate to uurine output of atleast 2ml/kg per hr in
any patient with significant burns or myoglobinuria
 Consider furosemide or mannitol for further diuresis of
myoglobin.
 Give tetenus vaccine as indicated and provide wound
care
 Treatment may include early fasciotomy when
necessary.

41.  These include accidents caused by venomous
animals.
 Thesei inlude:
• Snake bite
• Scopion stings

42.  Snake bites
 Snake bite should be considered in any case of severe pain or
swelling of a limb or in any unexplained illness presenting
with bleeding or abnormal neurological signs. Some cobras spit
venom into the eyes of victims, causingpain and iinflamation.
 Diagnosis
 ■ General signs include shock, vomiting and headache.
Examine bite for signs such as local necrosis, bleeding or tender
local lymph node enlargement.
 ■ Specific signs depend on the venom and its effects. These
include:
 – shock
 – local swelling that may gradually extend up the bitten limb
 – bleeding: external from gums, wounds or sores; internal,
especially intracranial.

43.  – signs of neurotoxicity: respiratory diffi culty
or paralysis, ptosis, bulbar palsy (difficulty in
swallowing and talking), limb weakness
 – signs of muscle breakdown: muscle pains and
black urine
 ■ Check Hb (when possible, blood clotting
should be assessed).

44. Firsr Aid
 Splint the limb to reduce movement and
absorption of venom. If the bite is Likely to have
been by a snake with neurotoxic venom, apply a
firm bandage to the affected limb, from fingers or
toes to near the site of the bite.
 Clean the wound.
 If any of the above signs are present, transport the
child to a hospital that has antivenom as soon as
possible. If the snake has been killed, take it with
the child to hospital.
 Avoid cutting the wound or applying a
tourniquet.

45. Hospital care
Treatment of shock or respiratory arrest
 Treat shock, if present.
 Paralysis of respiratory muscles can last for days
and requires intubation and mechanical ventilation
or manual ventilation (with a mask or
endotracheal tube and bag-valve system) by relays
of staff and/or relatives until respiratory function
returns.
 Attention to carefully securing the endotracheal
tube is important.
 An alternative is to perform an elective
tracheostomy.

46.  Antivenom
 ■ If there are systemic or severe local signs (swelling of
more than half the the llimb or severe necrosis), give
antivenom, if available.
 Prepare IM adrenaline 0.15 ml of 1:1000 solution IM and IV
chlorphenamine, and be ready to treat an allergic reaction .
 Give monovalent antivenom if the species of snake is
known.
 Give polyvalent antivenom if the species is not known.
Follow the directions given on preparation of the
antivenom. The dose for children is the same as that for
adults.
 • Dilute the antivenom in two to three volumes of 0.9%
saline and give Intravenously over 1 h. Give more slowly
initially, and monitor closely for anaphylaxis or other
serious adverse reactions.

47.  If itching or an urticarial rash, restlessness, fever, cough or diffi cult
breathing develop, then stop antivenom and give adrenaline at 0.15
ml of 1:1000 IM
 possible additional treatment include bronchodiltaors, antihistamines
(chlorphenamine at 0.25 mg/kg) and steroids. When the child is
stable, re-start antivenom infusion slowly.
 More antivenom should be given after 6 h if there is recurrence of
blood clotting disorder or after 1–2 h if the patient is continuing to
bleed briskly or has deteriorating neurotoxic or cardiovascular signs.
 Blood transfusion should not be required if antivenom is given.
Clotting function returns to normal only after clotting factors are
produced by the liver. The response of abnormal neurological signs to
antivenom is more variable and depends on the type of venom.
 If there is no response to antivenom infusion, it should be repeated.
 Anticholinesterases can reverse neurological signs in children bitten
by some species of snake .

48. Other treatments
 Surgical opinion: Seek a surgical opinion if
there is severe swelling in a limb, It is pulseless
or painful or there is local necrosis. Surgical care
will include:
 – excision of dead tissue from wound
 – incision of fascial membranes (fasciotomy) to
relieve pressure in limb compartments, if
necessary
 – skin grafting, if there is extensive necrosis
 – tracheostomy (or endotracheal intubation) if
the muscles involved inare paralysed.

49. Supportive care
 Give fluids orally or by nasogastric tube
according to daily requirements
 Kep a close record of fluid intake and output.
 Provide adequate pain relief.
 Elevate the limb if swollen.
 Give antitetanus prophylaxis.
 Antibiotic treatment is not required unless there
is tissue necrosis at the wound site.
 Avoid IM injections.
 Monitor patient very closely immediately after
admission, then hourly for atleast 24hrs, as
envenoming can develop rapidly.

50.  Broken glasses can cause serious cuts and so
use of the materials around the home in
furniture or fittings should be carefully
considered if you have a young family.

51.  When children start to move around on their
own, there is an increased danger of them
pulling objects down on top of themselves.
being conscious of your kids health means
making sure any trailing electrical leads,
tablecloth edges and dish towels are out of
reach in order to help prevent accidents
happening

52. References:
Pocket book of hospital care for children

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