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© PDLS : Disaster Specific Patterns of Injury Learning Objectives Identify potential injuries of the pediatric disaster victim. Describe appropriate interventions for managing these injuries. Classification of Emergencies Traumatic Emergencies Environmental Emergencies Psychological and Social Emergencies Traumatic Emergencies Head Trauma Spine and Spinal Cord Trauma Thoracic Trauma Abdominal Trauma Soft Tissue Injuries Musculoskeletal Injuries Classification of Traumatic Injuries Extent - multiple or local Nature - blunt or penetrating Severity - mild, moderate or severe Classification of Trauma by Severity Category History Vital Sign Findings Mild Minimal Force Normal Superficial Only Moderate Significant Force Normal Suspicious for Internal Injury Severe Abnormal Indicative of Internal Injury Critical Force Localized Head Trauma Assessment - history - vital signs - local findings Treatment Goals - prevent secondary brain damage - maintain good cerebral perfusion pressure Treatment - control external bleeding - oxygenate & hyperventilate as needed - fluid resuscitate to maintain adequate perfusion - keep head in midline position and HOB elevated 30 degrees - control seizures if possible Isolated Spinal Trauma Assessment - history (mechanism, amount of force) - vital signs - local findings (thorough neuro exam, palpation etc.) Treatment Goals - immobilization of the cervical spine and the child Treatment - appropriate size hard collar or rolls to immobilize the neck - back board or modified board with proper restraints Localized Thoracic Trauma Assessment - history (penetrating or blunt, amount of force) - vital signs - local findings (bony tenderness, decreased breath sounds etc.) Treatment Goal - maintenance of adequate oxygenation and ventilation Treatment - close monitoring of oxygenation - maintenance of adequate ventilation with assist if needed - oxygen delivery as needed - restore intravascular volume if needed for excessive blood loss Isolated Abdominal Trauma Assessment - history - vital signs - local findings Goal of Treatment - early assessment and prevention of complications Treatment - monitor ventilatory status and assist when necessary - decompress abdomen Soft Tissue Injuries Assessment - visual and palpation exam - vital signs Treatment Goals - prevention of complications Treatment - close monitoring of oxygenation - maintenance of adequate ventilation with assist if needed - oxygen delivery as needed - restore intravascular volume if needed for excessive blood loss Musculoskeletal Injuries Assessment - history (mechanism, force) - vital signs (peripheral perfusion) - local findings (discoloration, deformity etc.) Goal of Treatment - prevention of complications - minimize discomfort Treatment - ice, elevation, immobilization - frequent evaluation of peripheral vascular perfusion - reassess neuromuscular function Environmental Emergencies Burns and Thermal Injuries Smoke and Inhalation Injuries Hyperthermia Hypothermia Burns & Thermal Injuries Airway..Breathing..Circulation Assessment Fluid Therapy Care of the Burn Wound Pain Management Fluid Therapy for the Burn Victim Parkland Formula - 4 ml/kg/%BSA of crystalloid over the first 24 hours. - Half during the first 8 hours and half over the next 16 hours Rule of Thumb Children should produce 1 ml/kg/hr of urine ... Care of the Burn Wound Goals - promote rapid healing, prevent infection Cleanse - using large volumes of lukewarm sterile saline Cover - with loose, clean, preferably sterile dressings or sheets Pain Management for Burn Victim Covering burn from moving air Analgesic medications Drug of Choice - Morphine 0.1-0.5 mg/kg Smoke & Inhalation Injuries Assessment - Clinical Manifestations Treatment Hints of Smoke Inhalation Exam may show: - facial burns - singed nasal hairs - soot in pharynx - mental confusion Tachypnea, cough or stridor may or may not be present. Treatment of Smoke Inhalation Remove from contaminated environment CPR as needed Provide 100% supplemental oxygen Ensure patent airway Intubate early Hyperthermia Assessment Heat exhaustion - T < 39C, lethargy, thirst, headache, increased heart rate Heat stroke - T > 41C, hot skin, severe CNS dysfunction, circulatory collapse Treatment of Hyperthermia Remove clothing Begin active cooling Transport to cool environment Cardiovascular support Fluid Resuscitation < 20 mg/kg lactated Ringers or 0.9% sodium chloride Hypothermia Exam Pale or cyanotic, CNS function progressively impaired with falling temp. Frank coma occurs at approximately 27 C. Decreased BP, heart rate, or both Treatment for Hypothermia External Warming (for temp > 33C) - Blankets, warm baths Internal Warming (for temp < 32C) - Warm peritoneal lavage, warm nasogastric lavage, warm IV fluids Hazardous Materials Exposure Goal: to provide guidelines for scene management , care and transportation of patients contaminated by radiation or hazardous chemicals General Instructions Upon discovery of Hazmat scene, notify communication center to dispatch Hazmat expert Delay entry until appropriate team and protective equipment is available Expect the Hazmat team to initially remove any patients Follow advice of Hazmat team regarding personal protection or patient decontamination Additional Rules Don’t be a hero... Always maintain a high index of suspicion General Signs and Symptoms of Hazmat Exposure Local Effects - complaints of burning skin, teary eyes, dry or sore throat, a cough or sneezing. Systemic Effects - complaints of difficulty breathing, bizarre behavior, stupor, seizures, coma. Psychological & Social Emergencies Separation Anxiety Child Safety Lack of Communication and Comprehension Skills