This document discusses pediatric trauma, including causes, types of injuries, and approaches to assessment and management. It focuses on the primary and secondary surveys. The primary survey involves a rapid assessment of the child's ABCDE (airway, breathing, circulation, disability, exposure/environment) and resuscitation of any life-threatening injuries. Key priorities include airway control, ventilation, vascular access, and treatment of shock. Pain management is also addressed. The secondary survey allows a more thorough physical exam and diagnostic testing to identify all injuries present. Specific considerations for management of head trauma and chest injuries in children are also outlined.
Polytrauma and multiple traumata are medical terms describing the condition of a person who has been subjected to multiple traumatic injuries. This will be more prevalent in our country
Polytrauma and multiple traumata are medical terms describing the condition of a person who has been subjected to multiple traumatic injuries. This will be more prevalent in our country
Objective: At the end of this unit, the students will be able to:
Describe internationally accepted rights of child
Discuss national policies, legislation and agencies related to child welfare
Explain National Health Programs related to child health
Enumerate changing trends in child health
Outline child morbidity and mortality
Describe the ethics in Pediatric Nursing
At the end of unit 2, the students will be able to:
Appreciate the differences between children and adult
Describe the hospital environment for a sick child
Explain the impact of hospitalization on child
Discuss the grief and bereavement
Outline the role of a child health nurse
Explain the principles of pre- and post-operative care for children
Perform pain assessment in children
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
NVBDCP.pptx Nation vector borne disease control program
Pediatric Trauma
1. Pediatric Trauma- An area of concern
CNE- Trauma Care Nursing: Newer modalities perspectives and
Challenges
Venue- Base hospital , Delhi cantonment
Feb 9-10 , 2019
Prof. (Dr.) Smriti Arora
Amity College of Nursing
Amity University, Gurugram, Haryana
smritiamit@msn.com
2. Introduction
• Injury is the leading cause of death and disability in children
• accounts for a significant burden on countries with limited resources.
• There are anatomical, physiological, and emotional differences
between adults and children.
• The initial assessment and management of the injured child follows
• primary survey and resuscitation, followed by
• secondary survey.
3. Causes of pediatric trauma
• Road traffic incidents , hit by vehicle
• Fall injuries – at home
• Interpersonal violence
• Submersion injury
• Homicide
• Suicide
• Fires
5. Primary and secondary survey
• Primary survey is quick, initial patient assessment to identify life
threatening injuries and involves active resuscitation.
• Secondary survey identifies other injuries, such as intra-abdominal
injuries and long-bone fractures, which can result in significant
hemorrhage.
• The relief of pain is also an important part of the treatment of an
injured child.
6. Primary survey
• starts at the injury scene and aims to ensure a patent airway, adequate
breathing, circulatory support, and to assess major neurologic
disability.
• address life-threatening injuries that compromise oxygenation and
circulation.
• The priority of this initial phase is evaluation of the child's ABCDE.
• Every trauma patient should arrive boarded and C-spine immobilized.
• Collar for school-age/adolescents and
• Rolls and tape for infants/toddlers
7. AIRWAY
• Airway control is the first priority.
• Unlike in adults, the cause of childhood cardiac arrest is an initial
respiratory arrest. A child's airway is anatomically different from an
adult’s.
• A child has a shorter neck, smaller and anterior larynx, floppy
epiglottis, short trachea, and large tongue.
• classic sign of upper airway partial obstruction- inspiratory stridor
• complete airway obstruction- Respiratory effort with no air flow
8.
9. Airway
• If the airway is obstructed, inspect the mouth for a foreign body and remove it,
but do not perform a blind finger sweep, which may push it further into the
airway.
• Suction to clear blood, secretions, or vomitus.
• oral intubation- , use the jaw-thrust maneuver to improve airway patency.
• All pediatric trauma patients must be assumed to have cervical spine injury until
proven otherwise. Thus, if oral intubation is indicated, in-line cervical spine
immobilization must be performed.
• Size of the ET tube- by the child’s 5th digit or by the formula (age + 16)/4.
• The subglottic trachea is the narrowest portion of the pediatric airway and
provides a "physiologic cuff," so use uncuffed ET tubes in children <8 years in
order to minimize tracheal trauma.
• Use a rapid-sequence intubation technique to facilitate successful intubation.
10.
11. • Broslow tape - A reference at each color bar on the tape informs you
of equipment sizes to perform emergency resuscitation on the child.
A reference at each weight zone on the tape shows pre-calculated
medication dosages. Designated resuscitation equipment is contained
in corresponding, color coded equipment pouches.
12.
13. BREATHING
• Once a patent airway is established, carefully assess the child's breathing. If
respiration is inadequate, provide ventilatory assistance.
• Infants and small children are primarily diaphragmatic breathers; their ribs
lack the rigidity and configuration present in adults.
• As a result, any compromise of diaphragmatic excursion significantly limits
the child's ability to ventilate.
• Direct injury to the diaphragm, disruption and herniation of intra-
abdominal contents, or gastric distension (aerophagia) can severely
compromise the infant or small child's ability to breathe.
• The mediastinum of a child is very mobile; therefore, mediastinal
structures can shift into the contralateral hemithorax as a result of a simple
pneumothorax, hemothorax, or tension pneumothorax.
14.
15. Breathing
Anticipate respiratory failure if any of the following signs is present:
• an increased respiratory rate, nasal flaring, retractions, seesaw
breathing, or grunting;
• an inadequate respiratory rate, effort, or chest excursion (e.g.
diminished breath sounds or gasping), especially if mental status is
depressed;
• cyanosis with abnormal breathing despite supplementary oxygen.
• absent or asymmetric breath sounds - pneumothorax
16.
17. CIRCULATION
• Assess for hypovolemic shock.
• Tachycardia is usually the earliest measurable response to
hypovolemia.
• Other signs- mental status change, respiratory compromise, absence
of peripheral pulses, delayed CRT, skin pallor, and hypothermia are all
possible early signs of shock that must be immediately recognized.
• Children maintain a near-normal blood pressure even in the face of
25% to 30% of blood volume loss. In these situations, subtle changes
in the HR and extremity perfusion may signal impending
cardiorespiratory failure.
18. Circulation
• Obvious signs of shock such as
• hypotension
• decrease in urinary output
may not occur
until more than
30% of blood
volume has been
lost
19. Circulation ABC
• Make vascular access the next priority once adequate ABCs are
established.
• If possible, place 2 percutaneous IV catheters in the upper
extremities.
• If peripheral venous access cannot be obtained after 3 attempts or in
< 90 seconds, establish IO access in children <6 years.
• A saphenous vein cutdown and cannulation of central veins are other
options, but these techniques should be reserved for stable patients
and skilled personnel.
20.
21. Circulation
• Initial fluid resuscitation- warm isotonic crystalloid solution (RL or
isotonic NS solution) at a bolus of 20 mL/kg.
• The goals of the initial resuscitation should be to achieve
hemodynamic normality and to restore adequate tissue perfusion as
soon as possible.
• Children with evidence of hemorrhagic shock who fail to response to
fluid resuscitation should also receive blood (10 mL/kg) and be
evaluated by a pediatric surgeon for possible operative intervention.
22. Disability ABCD
• Causes of decreased level of consciousness in injured children include
traumatic brain injury (TBI), hypoxemia, and poor cerebral perfusion.
• Assess Neurologic status
• [AVPU] system
• pediatric Glasgow Coma Scale [GCS]- describes level of consciousness in TBI,
categorize head injury
23. • E4V5M6
• Max score – 15
• Min 3 – coma
• <8 – intubate
24. Environment and Exposure ABCDE
• larger body surface area to body mass ratio predisposes them to larger
heat and insensible fluid loss than adults, resulting in higher fluid and
caloric requirements.
• Avoid accidental hypothermia during the initial phase of resuscitation.
• Hypothermia results in vasoconstriction, low-flow state, acidosis, and
consumptive coagulopathy.
• To prevent hypothermia:
➢use warm intravenous fluids.
➢Once the patient is exposed, cover the patient with a warm blanket.
➢Connective air rewarmers and warmed, humidified ventilation can help maintain
core body temperature if hypothermia is detected (< 35°C/95°F).
➢Peritoneal lavage with warm saline
➢Extracorporeal circulatory rewarming- for patients with severe hypothermia (<
28°C/82°F) in association with ventricular fibrillation or arrest or with drowning in
cold water.
26. Pain control
• Once the primary survey has been completed, address the issue of
pain control.
• Pain relief can be provided with morphine (0.1 mg/kg) or a
combination of fentanyl (1 mcg/kg) and midazolam (0.5-0.1 mg/kg).
• Definitive treatment can be accomplished safely once hypoxia,
tachycardia, hypotension, and hypothermia have been managed.
The secondary survey involves a more detailed systemic evaluation and
initiation of diagnostic studies.
27. Adjuncts to Primary Survey
• Access: IV vs. IO
• Monitor: Cardiorespiratory/Pulse oximetry.
• Bloodwork - CBC, electrolytes, ABG, creatinine, BUN, PT/PTT,
crossmatch, LFT, lipase or amylase, BHCG if female of child-bearing
age
28. Imaging Prior to Secondary Survey
• Chest X rays: (AP only) , Pelvis (AP only) , C-spine: lateral, AP
• FAST- Focused assessment with sonography in trauma
29. Secondary evaluation
• Complete history taking
• Head to toe physical examination
• Neurological- LOC, Pupils, GCS
• Head, neck , spine
• Chest
• Abdomen
• Orifices, Rectum
• Musculoskeletal
• Reassessment of vital signs
30. Secondary survey
1. Head trauma
Management :
• Airway
• Cardiovascular and circulatory status
• Intracranial pressure and cerebral perfusion
• Bleeding, Seizures
• Temperature
• Analgesia, sedation, and neuromuscular blockade
Surgery: Surgical intervention in pediatric patients with head trauma may be required and includes
the following:
• Surgical decompression, Craniotomy and surgical drainage
• Surgical debridement and evacuation, Decompressive craniotomy with duraplasty
31.
32. 2. Chest Injuries
• Children have relatively elastic ribs, that fracture rarely, despite that lungs
contusion is common without ribs fracture.
• Major thoracic injuries may coexist despite normal radiographic findings like
1) Tension pneumothorax 2) Massive Haemothorax 3) Cardiac Tamponade
• In all cases airway should be secured, O2 is given and hypovolemia is corrected
with IV – fluid. Diaphragmatic rupture after blunt abdominal trauma can be
detected by chest x-ray or CT-scan, surgical repair is undertaken once the pt
become stable
• Tension Pneumothorax: Tension pneumothorax requires prompt clinical diagnosis
and immediate needle thoracocentesis. Site- 2nd ICS , “midclavicular line”.
Thoracocentesis is followed by chest tube drainage.
• Massive Haemothorax: it is treated by chest tube drainage via “fifth intercostals
space midaxillary line”.
• Cardiac Tamponade: Cardiac tamponade may follow blunt or penetrating chest
injury. It require emergency needle “pericardiocentesis”.
33.
34.
35. 3. Abdominal Trauma
► Blunt abdominal trauma is generally more common than penetrating
injury.
► In children more vulnerable organs are liver and spleen because they are
not protected by pliable rib cage.
Fluid resuscitation - 20 ml/kg of RL as bolus, may repeat 1-2 times.
Investigations used In Abdominal Trauma
► The definitive radiological investigation of major abdominal trauma in
haemodynamically stable child is CT – scan with IV – contrast.
► Expert ultrasound scanning is readily available it can demonstrate free
abdominal fluid and solid organ injuries but it is not valuable as CT
► Exp. Laparotomy is indicated for bowel perforation and penetrating
trauma.
36. 4. Burn/Thermal Injury
Management :
• ABCDE
• Consider early intubation if airway involvement
• Tetanus prophylaxis and ANALGESIA
• Fluid resuscitation mainstay of treatment
• Parkland Resuscitation Formula: using Ringer’s Lactate, Give 4ml/kg/%TBSA
• First half of resuscitation fluids (AS WELL AS MAINTENANCE FLUIDS) over
first 8 hours and Second half over following 16 hours
• Urine output goal: 1-2 ml/kg/hour
37. Prevention of pediatric trauma
• Supervision of children during play
• Commitment by healthcare workers to the pediatric trauma
population.
• Public education regarding automobile safety, firearm safety, and
burn prevention
• Pediatric life-support courses for providers of care
• Legislation regarding establishment and enforcement of seat belt
laws, increased enforcement of drunk driving statutes, firearm
registration, establishment of trauma registry.
38. Preventing falls
• Evaluating mental status, Call light within reach
• Environment clear of hazards and unused equipment
• Orientation to the room
• Bed in low position with brakes on
• Side rails raised as necessary based on the child’s age and cognition
• Nonskid footwear and appropriate-size clothing
• Child and family education
• Checks of the child at least every hour
• Accompaniment of the child during ambulation
• Assessment of the need for 1:1 supervision
40. Summary
• Experiences with accidents, injuries, physical abuse, or
hospitalization can leave a lasting impact on children's
minds. Thus psychosocial support .
• ABCDE
• Age appropriate assessment, equipment, and
dosing