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32 Cards in this Set
- Front
- Back
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leading causes of injury-risks
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MVA passenger or pedestrian
assault/abuse/suicide drowning burns fall from heights bike accidents |
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what is the #1 cause of death in pedi patients
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head injuries, occur with 75% of multiple trauma
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what are head injuries the number one risk
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small infant LARGE head
thin skull mean less protection incompletely myelinated nervers are more easily damamged |
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difference in assessment b/w children and adults
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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 |
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nursing interventions for head truama
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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) |
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what should you always assume with a head/chest injury
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cervical spine injury
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who is at higher risk for c-spine injury
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down's children
small children in facing forward car seat |
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what should you do if suspect c-spine injury
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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 |
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Nursing interventions for treating hypotension
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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 |
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ways to evaluate sources of unidentified blood loss
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blood lost at ax scene
bleeding into body cavity (chest, abd. retroperitoneal) soft tissue bleed (fx femur) Intracranial bleed- <6mo |
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what is the leading cause of unrecognized fatal injury in children
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missed abdominal bleeding
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what can you do to replace fluids if you can't get an IV in
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intraosseous fluids
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head to toe assessment
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head
loc NG tube inserted neck and chest abd, pelvis and rectum foley cath extremities, neuros back and skin |
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what are your assessment priorities
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airway
breathing circulation hemorrhage neuro staus total body assessment |
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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 |
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lab tests
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H&H- immediately for baseline and then again later
UA- bloody? bladder trauma Amylases-pancreatic cardiac liver x-rays |
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complications of chest and ABD trauma Assessments
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PNEUMOTHORAX- tracheal deviation, <breath sounds, >RR, >HR
FLAIL CHEST-stabilize, intubate, ventilate HYPOTENSION- think hemorraghe PERICARDIAL TAMPONADE-bleeding into pericardial sac |
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Nursing interventions for FX
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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 |
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soft tissue trauma
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pressure to stop bleeding
dress open wounds amputated parts-place moist sterile gauze, wrap in plastic, put on ice |
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SIGNS OF SIGNIFICANT HEAD INJURY
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-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 |
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seizures
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patho
increased metabolism increased O2 need reduced ability to ventilate RF aspiration breathing pattern ineffective |
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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" |
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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 |
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what is the danger period after a trivial trauma
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1-10 weeks post injury a severe spinal injury can occur from a trivial trauma
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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 |
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Trivial signs of external traums may been indicitive of....
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internal organ injury. this is due to increased cartilidge. object can bounce in, cause damage then bounce out.
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RN considerations for the intra-abd injury
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DO FREQ ASSESSMENTS
weal musculature mean less protection for internal organ liver/spleen vulnerable |
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what is sig. about a bruised flank?
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it is a sign of vascular hemorrhage and risk of .
kidney damage and possibly need emergency surgery |
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where are multiple traumas best treated?
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tertiary centers
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EVULSED TOOTH
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know policy
parent cleans and reinserts tooth per protocol tooth is placed in cold milk or child's mouth to be bathed in saiva |
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EYE INJURIES
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NEVER REMOVE A PENETRATING OBJECT
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ASSESSMENT PRIORITIES
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AIRWAY
BREATHING+ ATTENTION TO c-SPINE CIRCULATION HEMORRHAGE NEURO STATUS -A&O X3 -GLASCOW COMA SCALE TOTAL BODY ASSESSMENT |
