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Emergency Splinting and Trauma First Aid
Objectives
•Review the most common injuries in children
•Discuss what to ask, examine and do for each process
•Suggest who needs further care and who can return to class
Common Injuries
•Bumps and Bruises•Scrapes•Sprains•Strains•Fractures
•Oral Trauma•Nose Bleeds•Lacerations•Head Injuries•Overheating
Bumps and Bruises•Bobby Bobo, a 5 y/o boy, fell
down in class while chasing the teacher’s lost hamster. He hit his right thigh on the corner of
a desk and now complains of pain and swelling to the leg.
By the time he arrives his right thigh is tight from the swelling.
He says he has “Christmas Disease”.
Bumps and BruisesWhat to ask?
•What happened and when?▫Abuse vs. accidental
Inconsistent mechanism, frequent bruisingAbnormal locationsAbnormal patterns▫No trauma? Think mass, infection,
clotting d.o .•Anything else hurt ?•PMHx? (Aspirin, coumadin, bleeding…)
Bumps and Bruises
What to examine?•Entire body
▫Look for patterns▫Suspicious locations
TrunkFaceScalp▫Multiple stages of bruises?
•Bone pain?
Nonaccidental Trauma
Bite
Bumps and Bruises
What to do?•Cold pack•Tylenol •Most need nothing•CPS?
▫Law is “if suspicious…report”.▫You are protected▫Confidential
Texas Law
•Child abuse and neglect are against the law in Texas, and so is failure to report it .
•If you suspect a child has been abused or mistreated, you are required to report it to the
Texas Department of Family and Protective Services or to a law enforcement agency .
•You are required to make a report within 48 hours of the time you suspected the child has
been or may be abused or neglected .Abuse Hotline 1-800-252-5400
Bumps and Bruises
Where to send them?•Back to class
▫Most▫Not rapidly expanding▫Not suspicious
•Doctor▫Large/deep, multiple, expanding ▫Uncertain of etiology
(mass/infection/abuse)
Scrapes
•A 9 y/o girl, Terri Tawmboi, is brought
to you after she got “a huge raspberry”
playing kickball at recess. Her right
knee is bleeding and covered with grass
and dirt .
Scrapes
What to ask?•What happened?•What did you fall on?
▫Hard versus soft▫Loose objects = foreign bodies
•Able to bear weight?•Anything else hurt?•Vaccinations (Tetanus) ?
Scrapes
What to examine?•Wound
▫Deep vs. superficial▫Clean vs. contaminated▫If old, infected? Impetigo
•Range of motion•Weight bearing
Scrapes
What to do?•Gently clean
▫Saline and gauze▫Clean wet washcloth▫Running tap water
•Remove debris •Antibiotic ointment•Bandage
Scrapes
Where to send them?•Back to class almost always•Doctor
▫Retained foreign body▫Restricted use of extremity▫Concern for joint penetration
Sprains
•Trey Studmuffin, your transfer, red-shirt, freshman, power-
forward, “came down wrong” on a teammate's shoe during
tryouts. He hops into the office on one foot asking you to “tape
me up”!
Sprains
What to ask?•What happened?
▫MechanismTwist or turnBlunt trauma“Something popped” or “gave way”▫Could you walk on it (even with a limp) ?
•Old injury, ask if fever, chills, medical hx.
Sprains
What to examine?• Entire involved extremity
▫Pain▫Swelling▫Bruising▫Redness▫Warmth▫ROM, gait
•Other joints
Ankle Sprain
Knee Sprain
Septic Joint
Sprains
What to do?“ pRICEmmms”
•Protect the joint = crutches, slings, tape…
•Rest•Ice•Compression•Elevation•Medication, modality (PT), motion (keep
loose)•Strength
Sprains
Where to send them?•Back to class
▫Most▫Pain under control
•Doctor▫Suspect fracture, infection, systemic
disease▫Not weight bearing▫Pain poorly controlled
Strains•Coach Oldskool, your legendary, and
older than he wants to admit, football coach crawls into your clinic
complaining, “I popped my back showing my History Class how to chop
block on a double reverse”.
Strains
What to ask?•What happened?
▫Sudden jerking movements?▫Lifting?▫Sprinting?▫Jumping?
•Did you feel a pop? Tear?•Numbness/tingling/weakness?
Sprain Mechanisms
Strains
What to examine?•Where it hurts
▫Spasm▫Swelling▫Bruising
•Joints above and below •Neuorologic function (back injuries) •Gait
Strains
What to do?•Similar to strains•Massage/stretch if spasm
Strains
Where to send them?•Back to class
▫Most▫Pain controlled
•Doctor▫Not bearing weight▫Severe pain▫Any numbness/tingling/weakness
Fractures
•Morgan Fleahopper, the 85 lb. head cheerleader, and
the one always at the top of all those stacks of girls, fell
off the infamous “Pyramid of Victory” at the 7 a.m. walk through. Her left
elbow is pointing the wrong way but her make-up
remains flawless .
Fractures
What to ask?•Describe the injury?
▫Fall vs. blunt trauma vs. twist▫How did you land?▫Where is the worst pain (use one finger)?▫Could you walk right afterward?▫Anything else hurt?
•Neck pain/back pain if severe fracture(s)?
Fractures
What to examine?•Point tenderness/deformity•Open fracture•Joint swelling•Muscle spasms•Function/sensation below fracture•ROM/walk•Neck/back if “distracting injury”
Fractures
What to do?•Stabilize = Splinting
▫Joint above and below fracture▫Not too tight, use padding▫Not too loose, shouldn’t wiggle▫Don’t hide the extremity, not
circumferential•Pain control
▫Ice▫Medications
Ankle Pillow Splint
Lower Leg Splint
Long Leg Splint
Finger Splints
Wrist (Volar) Splint
Upper Arm Splint
Cervical Spine Splints
Fractures
Where to send them?•Doctor
▫Most▫EMS if severe, neurovascular changes,
spine•Back to class
▫Broken hearts▫Shattered dreams▫Crushed morale
Oral Trauma
•Dirk Noteeski catches an elbow
during a scrimmage and comes in
grinning, with his two front teeth in his
hand. His mouth is full of blood .
Oral Trauma
What to ask?• What happened?
▫Tooth/jaw/lip/tongue hurt?▫What hit you? (BAD if it is another
person)▫How long ago?▫Permanent teeth?
•Where are the teeth ?•Have a dentist?
Oral Trauma
What to examine?• Teeth
▫Avulsed (knocked out, loose)▫Fractured▫Chipped▫Intrusion
• Jaw/face: feel for “crunchy” sensation• Mucosal/tongue injury
Tooth Anatomy
Avulsed Teeth
Fractured Teeth
Intrusion
Tongue/Mucosal Trauma
Oral TraumaWhat to do?
• Teeth▫Avulsion
Primary teethOut, leave outLoose, straighten or is very loose remove
Permanent teethOut, leave out, wash gently, store in cold milk,
saline, spit.Loose, leave alone
▫Fracture, keep fragment, store as above
Oral Trauma
What to do?•Tongue
▫Well approximated, nothing▫Bleeding direct pressure with gauze▫Gaping need repair
•Mucosal▫Well approximated, nothing▫Gaping and vermillion border need
repair
Oral Trauma
Where to send them?•Dental injuries
▫Dentist for most injuries▫Baby teeth may need nothing
•Tongue/Mucosa▫Most need nothing▫Doctor if gaping, severe bleeding,
vermillion
Nose Bleeds
•Little 8 y/o Penny Piksalot is rushed to you with gushing blood from her left nare .
Nose Bleeds
What to ask?•How much blood, how long?•What has been done to stop bleeding?•Trauma?
▫Blunt▫Picking
•Upper respiratory infection? Allergies?•History of Bleeding?
Nose Bleeds
What to examine?• Nose
▫Fracture (usually at bridge)▫Active bleeding
Which side? Always the same?Throat
•Neurologic•Vision
Nose Bleeds
What to do?•Pinch x 10-20 minutes (don’t peek)•Don’t put head between legs•Don’t blow nose•Afrin if available•No PICKING!
Penny’s Father
Nose Bleeds
Where to send them?• Back to class
▫Most if stops after 20 minutes▫No other injury▫Not dizzy, weak, pale
•Doctor▫Severe bleeding▫Bleeding disorder▫Other injuries
Lacerations
•Paris Marriott is back from the South of France for a little quality time with
friends when she crashes daddy’s SLK into a parked bus in the Faculty Lot. She
comes in screaming with a 1/8th cm “gash” to her right cheek. She’s suing
the bus driver and wants the school plastic surgeon called “now”!
Lacerations
What to ask?•How did it happen?
▫Sharp vs. blunt force?▫Fall, if so how high?▫Foreign body, dirty?▫Puncture?▫How long ago?
•Tetanus status
Lacerations
What to examine?•Wound
▫How wide?▫How deep?▫How long?▫Contaminated?▫Across nerves/tendons/vessels/galea?
•Head/spine injury?•Fracture?
Scalp Laceration
Forehead Laceration
Hand Laceration
Lacerations
What to do?•Stop bleeding
▫Wear gloves▫Direct pressure▫1 gauze at a time
• Decide if repair needed▫No wash, antibiotic ointment,
bandage▫Yes wash, cover with saline soaked
gauze(s)
Lacerations
Where to send them?•Doctor
▫Most▫ All if:
ContaminatedPersistent bleedingAcross/near vital structuresAssociated with fracture
• Back to class if very superficial
Head Injuries
•Goofus McDoofus, the class clown, thought it would be
hilarious to hang upside down from the goalposts at P.E.. He
fell 10 feet and stuck the landing with his noggin. You
run to find him “out cold” with a few hundred people trying to
wake him up.
Head InjuriesWhat to Ask?
•What happened?▫Witnessed?▫Fall vs. blunt
trauma?▫How far/hard?▫What surface?▫How landed?
•Symptoms▫Loss of consciousness?
Immediate/delayed?How long?Motor activity?
StiffJerkingLimp
▫Vomiting?Immediate vs. delayed?How many times?▫Weak/numb/AMS?
•Headache?▫Severity▫Worsening
•Neck/back injury•Other pain?•H/o seizures, fainting?•Medications
Head InjuriesWhat to Ask?
Head Injuries
What to examine?•Head
▫Contusions, feel for the bottom▫Step off (depressed skull fracture)▫Lacerations▫Battle sign/Racoon eyes
•Spine (top to bottom)•CNS/other injuries
Depressed Skull Fracture
Battle Sign
Raccoon Eyes
Intracranial Bleeding
Epidural Hematoma Brain Contusion
Head Injuries
What to do? Where to go?• Assume spine injury
▫Stabilize C-spine▫Keep child still, laying down
• EMS▫Loss of consciousness▫Persistant mental status changes
•Back to class if mild, asymptomatic after
Overheating
•Smoky Johnson is trying to get his weight down for
his big wrestling match on Friday and is found
“acting funny” after running a few laps during PE. It’s 102 degrees and he is wearing two sweat suits and a wool ski cap.
OverheatingWhat to ask?
•What’s wrong?▫Heat rash small red bumps in hottest areas▫Heat cramps arms/legs/abdominal muscles▫Heat exhaustion Dizzy, nausea, vomiting,
headaches, weakness, muscle pain, clammy.▫Heat stroke Above except dry skin,
confused (to coma), seizures, dry hot skin•How did it happen?•Medications/drugs ?
Overheating
What to examine?•Take core temperature
▫T 104 for Heat Stroke▫May be normal for others
•Mental status•Skin•Pulses
OverheatingWhat to do?
•Remove from heat
•Rapidly cool
Overheating
Where to send them?•Heat rash back to class•Heat cramps usually back to class•Heat exhaustion Doctor, EMS if severe•Heat stroke EMS, life threatening
Thank You!