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32 Cards in this Set

  • Front
  • Back
leading causes of injury-risks
MVA passenger or pedestrian
assault/abuse/suicide
drowning
burns
fall from heights
bike accidents
what is the #1 cause of death in pedi patients
head injuries, occur with 75% of multiple trauma
what are head injuries the number one risk
small infant LARGE head
thin skull mean less protection
incompletely myelinated nervers are more easily damamged
difference in assessment b/w children and adults
both have ICP but kids have higher freq with head injury
children have more global injuries and adults more local
children show immediate s/s ICP and adults show s/s more slowly
nursing interventions for head truama
treat HYPOXIA AND HYPOTENSION
* shock takes priority*
aggressive airway management
Bag valve mask-O2 to reduce PCO2(which causes vasodilation)
administer meds if high intravascular volume. I.E. steroids, diuretics and barbituates (resp monitor)
what should you always assume with a head/chest injury
cervical spine injury
who is at higher risk for c-spine injury
down's children
small children in facing forward car seat
what should you do if suspect c-spine injury
stabilize the head and neck- align the auditory meatus w/ the shoulder in the coronal plane.
get down to child's level and talk to child
use parents if possible
KEEP CHILD WARM- to avoid coagulopathy
Nursing interventions for treating hypotension
done so shock doesn't occur
treat hypotension aggresively
10-20/ml/kg bolus iv LR
then when stable D5 1/2 NS
VOLUME REPLACEMENT
ways to evaluate sources of unidentified blood loss
blood lost at ax scene
bleeding into body cavity (chest, abd. retroperitoneal)
soft tissue bleed (fx femur)
Intracranial bleed- <6mo
what is the leading cause of unrecognized fatal injury in children
missed abdominal bleeding
what can you do to replace fluids if you can't get an IV in
intraosseous fluids
head to toe assessment
head
loc
NG tube inserted
neck and chest
abd, pelvis and rectum
foley cath
extremities, neuros
back and skin
what are your assessment priorities
airway
breathing
circulation
hemorrhage
neuro staus
total body assessment
added assessments
SAMPLE
S-signs and symptoms
A-allergies
M-medications
P-pertinent hx
L-last oral intake (assume stomach is full)
E-events leading to injury
lab tests
H&H- immediately for baseline and then again later
UA- bloody? bladder trauma
Amylases-pancreatic
cardiac
liver
x-rays
complications of chest and ABD trauma Assessments
PNEUMOTHORAX- tracheal deviation, <breath sounds, >RR, >HR
FLAIL CHEST-stabilize, intubate, ventilate
HYPOTENSION- think hemorraghe
PERICARDIAL TAMPONADE-bleeding into pericardial sac
Nursing interventions for FX
spinal column-immobilize
LONG BONES- splint and femur traction
OPEN FX- sterile dressing treat w/i 6h to prevent osteomylitis
-PELVIC FX- assess blood loss
soft tissue trauma
pressure to stop bleeding
dress open wounds
amputated parts-place moist sterile gauze, wrap in plastic, put on ice
SIGNS OF SIGNIFICANT HEAD INJURY
-Battles sign- bruised, swollen behind ear. means basal skull fx
-hemotympanum- bloody ear drum, blood leaking out ear
-orbital ecchymosis- black eye
CSF otorrhea or rhinorrhea- test clear liquid for glucose to see if it is CSF
seizures
patho
increased metabolism
increased O2 need
reduced ability to ventilate
RF aspiration
breathing pattern ineffective
Spinal cord injury w/o radilogic abnormality for
define and cause
unique to pedi/no spinal column injury detected on XRAY
cause- the spinal column can elongate 2" but the cord can elongate 1/2"
Spinal cord injury w/o radilogic abnormality
symptoms
may be delayed 30min to 4 day
paresthesia in legs and hands, generalized weakness, lightening(burning sensation) down spine with head movement
what is the danger period after a trivial trauma
1-10 weeks post injury a severe spinal injury can occur from a trivial trauma
Abdominal and thorasic injuries
Signifigence of abd distention
may be caused by abd bleedeing. may need immediate laporotomy.
organ injury in children is difficult to assess
Trivial signs of external traums may been indicitive of....
internal organ injury. this is due to increased cartilidge. object can bounce in, cause damage then bounce out.
RN considerations for the intra-abd injury
DO FREQ ASSESSMENTS
weal musculature mean less protection for internal organ
liver/spleen vulnerable
what is sig. about a bruised flank?
it is a sign of vascular hemorrhage and risk of .
kidney damage and possibly need emergency surgery
where are multiple traumas best treated?
tertiary centers
EVULSED TOOTH
know policy
parent cleans and reinserts tooth per protocol
tooth is placed in cold milk or child's mouth to be bathed in saiva
EYE INJURIES
NEVER REMOVE A PENETRATING OBJECT
ASSESSMENT PRIORITIES
AIRWAY
BREATHING+ ATTENTION TO c-SPINE
CIRCULATION
HEMORRHAGE
NEURO STATUS
-A&O X3
-GLASCOW COMA SCALE
TOTAL BODY ASSESSMENT