Animal Bites & Stings (PEDIATRIC)

Transcription

1 Animal Bites & Stings 1 ABC s Oxygen (as needed) Bandage & mmobilization site Cold packs can be applied for comfort NTRMAT V of LR Treat for hypotension/shock (if present) ARAMC Note and treat signs of: o Anaphylaxis o Cardiac Anomalies o Shock Management: ALS, shock, anaphylaxis, pain, and anxiety ALRTS: Scene Safety Location and species of Animal or nsect/s og and Cat bites are required by Texas State Law to be reported to Law nforcement and or R physician

2 Burns 2 liminate source of burn ABC s o Monitor Vital Signs o Support life-threatening problems associated with airway, breathing, and circulation Support airway and provide supplemental Oxygen if Oxygen Saturation by pulse oximetry is less than 94% o No gag reflex consider the insertion of the King Airway (rocedure 4) TCO2 monitoring (rocedure 7) o nsure that a blood glucose reading is obtained, refer to iabetic mergencies (edi Medical 5) lace the patient in a position of comfort etermine percent of BSA & depth (Figure 1) Treat associated trauma ress wounds appropriately: o ry, sterile dressing o Moist sterile dressings for burns less than 20% BSA 12 Lead CG, Transmit (electrical burns) o Consider Air Medical (A 1) or Bypass NTRMAT nitiate V/O; NS TKO (in unburned area, if possible) Fluid Resuscitation: major burns > 15% 2nd or 3rd degree 0.25 / kg (x % BSA) / 1 hour for the first 8 hours Advanced Airway procedures if needed o Video laryngoscope Continued

3 Burns ARAMC 2 Advanced Airway procedures if needed o Rapid Sequence nduction (rocedure 1/1A) o Surgical Cricothyrotomy (rocedure 2) ain Management (edi Medical 4) 12 Lead CG Figure 1 Continued

4 Burns 2 ALRTS: Scene Safety o not give anything by mouth o not use wet dressing for any burn greater than 20% BSA Remove Jewelry atient with burns & trauma should be referred to the nearest appropriate trauma center, not a burn center Lethal cardiac dysrhythmias can be caused by low voltage exposures. Fatal dysrhythmias usually occur immediately, but other dysrhythmias can emerge at any time if the heart has been electrically injured tic injuries can be caused by high voltage exposures and often include internal injuries and burns HAZ-MAT exposure: Contact HAZ-MAT personnel. Mass casualty incidents should first be monitored from a distance until the Hazardous Materials can be identified. CHMTRC: Brush away dry powders before gross CON f Air Medic is unavailable, consider hospital by-pass

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6 Chest / Abdominal njuries 3 ABC s o Monitor Vital Signs o Support life-threatening problems associated with airway, breathing, and circulation Support airway and provide supplemental Oxygen if Oxygen Saturation by pulse oximetry is less than 94% o No gag reflex consider the insertion of the King Airway (rocedure 4) Treat for Hypotension / Hypovolemia / Shock (edi Medical 10) mpaled Objects: o o not attempt to remove any impaled object o Stabilize with bulky dressings or other means o For large or unwieldly objects, attempt to cut object no less than 6 inches from the patient Open or enetrating injuries to the chest or upper back: o Cover with occlusive dressing and seal on 3 sides use commercial device f patient deteriorates, remove dressing then reapply Flail Chest Respiratory istress: o Consider positive-pressure ventilation for severe distress o Bulky dressings O NOT apply weight to flail segments enetrating Abdominal njuries: o Apply occlusive dressings around site o viscerations, cove the organs with a saline-soaked dressing and then cover with an occlusive dressings o O NOT attempt to put the organs back into the abdomen TCO2 monitoring (rocedure 7) lace the patient in a position of comfort Consider 12 Lead CG, Transmit Continued

7 NTRMAT Chest / Abdominal njuries nitiate V/O; NS TKO o Hypotension, titrate to 70mmHg + (age in years x2) systolic B/ o 20 ml/kg warm NS bolus Asses for flail segment and tension pneumothorax Advanced Airway procedures if needed Video laryngoscope (T Tube selection) 16 + Age in years 4 ARAMC Attach CG monitor. Carefully monitor for dysrhythmias during the period immediately after release of pressure and during transport (i.e. peaked T waves, wide QRS, lengthening QT interval, loss of wave) o ain Management (edi Medical 14) o For suspected tension pneumothorax, perform Chest ecompression (rocedure 3) Massive Flail Chest with respiratory compromise o Consider intubation or Rapid Sequence ntubation (rocedure 1/1A) tic Asphyxia: o Support ventilation with BVM o 250 ml V bolus immediately after removal of compressive force ALRTS: Signs & Symptoms of Tension neumothorax : o ncreasing respiratory distress or hypoxia o ncreasing signs of shock including: Tachycardia Hypotension iminished or absent lung sounds JV ossible tracheal deviation above the sternal notc 3

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9 Crush njury 4 ABC s o Monitor Vital Signs o Support life-threatening problems associated with airway, breathing, and circulation Support airway and provide supplemental Oxygen if Oxygen Saturation by pulse oximetry is less than 94% o No gag reflex consider the insertion of the King Airway (rocedure 4) TCO2 monitoring (rocedure 7) Consider, 12 Lead CG, Transmit Asses and treat visible wounds NTRMAT nitiate V/O; NS TKO o f patient is hypotensive, 20 ml/kg as needed to restore perfusion (Max 3 boluses) Advanced Airway procedures if needed ARAMC Attach CG monitor o Carefully monitor for dysrhythmias during the period immediately after release of pressure and during transport (i.e. peaked T waves, wide QRS, lengthening QT interval, loss of wave) o ain Management (edi Medical 14) For patient entrapped in excess of 60 minutes, consider the following: o Albuterol 2.5 mg (Rx: 3), via nebulizer for a total of 3 doses or 7.5 mg for suspected hyperkalemia o Sodium Bicarbonate 1 mq/kg (Rx: 30), V over 2 minutes (May be repeated at 0.5 mq/kg after 10 minutes) Continued

10 Crush njury 4 o Calcium Chloride mg/kg (Rx: 8), slow V push o Ketamine mg/kg (Rx: 19) V/O administered over 1 minute May repeat once in 5 minutes as needed Consider Ketamine OR tomidate for a stun dose prior to potential painful movements of injured extremities o Ketamine 0.2 mg/kg (Rx: 19) V/O administered over 1 minute (may take up to 1minute for full effect) May repeat once in 5 minutes as needed o Ketamine 3 mg/kg M/N (may take up to 5 minutes for full effect) OR o tomidate (Rx: 14) 0.03 mg/kg V ALRTS: Crush syndrome is a life-threatening condition caused by prolonged compression or immobilization. Remember that the greater the body area compressed and the longer the time of entrapment, the greater the risk of crush syndrome. Signs and symptoms appear after the patient is released from the crushing mechanism or immobilization. Shock and possible metabolic acidosis occur as a result of release of toxins and end products of anaerobic metabolism Sodium Bicarbonate 1 mq/kg V may be mixed in 1 liter of Normal Saline hysician may be called to scene for prolonged extrication or high level compression, for additional medications, or more efficient medical direction (Contact MCOM ) Crush syndrome development before prophylatic treatment may require volume load and concurrent critical medication administration f medical and extrication conditions permit, initiate treatment prior to removal of compression mechanism

11 rowning / Near rowning 5 ABC s o Monitor Vital Signs o Support life-threatening problems associated with airway, breathing, and circulation Support airway and provide supplemental Oxygen if Oxygen Saturation by pulse oximetry is less than 94% o No gag reflex consider the insertion of the King Airway (rocedure 4) Obtain specific history: time, temperature, associated trauma, etc Consider Hypothermia (edi Medical 7) Remove wet clothes TCO2 monitoring (rocedure 7) f the child in < 12 years old and is able to fit the CA mask consult with the on duty physician Consider manual stabilization and spinal immobilization if the possibility of suspected head or c-spine injury exist (rocedure 20/20A) NTRMAT nitiate V/O; NS TKO o f patient is hypotensive, 20 ml/kg as needed to maintain or restore perfusion o Repeat once for a total of 40 ml/kg Advanced Airway procedures, if needed ARAMC rovide continuous KG monitoring Advanced Airway procedures, if needed (rocedure 1/1A) (rocedure 2) (rocedure 4) Continued

12 rowning / Near rowning 5 ALRTS: Manage ABC s prior to injury stabilization Factors affecting survival include patient s age, time submerged, general health, cleanliness of water and temperature ven patients that are conscious and appear well after a submersion event require hospital level evaluation and observations for delayed symptoms

13 lectrocution & Lightening Strike 6 ABC s o Monitor Vital Signs o Support life-threatening problems associated with airway, breathing, and circulation Support airway and provide supplemental Oxygen if Oxygen Saturation by pulse oximetry is less than 94% o No gag reflex consider the insertion of the King Airway (rocedure 4) TCO2 monitoring (rocedure 7) Assess and treat visible wounds (look for exit wounds) Burns present (edi 2) 12 Lead CG, Transmit (electrical burns) NTRMAT nitiate V/O; LR TKO o 20 ml/kg as needed to maintain or restore perfusion o Maximum of 3 boluses Advanced Airway procedures if needed ARAMC CG monitor Carefully monitor for dysrhythmias Advanced Airway procedures as needed ain Management (edi Medical 14) ALRTS: Scene Safety Be prepared for Cardiac Arrest Asses for xit Wounds

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15 Fractures & islocations 7 ABC s o Monitor Vital Signs o Support life-threatening problems associated with airway, breathing, and circulation Support airway and provide supplemental Oxygen if Oxygen Saturation by pulse oximetry is less than 94% Stabilize fracture, use appropriate splint / position of comfort valuate for Alert Criteria (A 23) atient meets Alert Criteria, activate Air Medical (A 1) NTRMAT nitiate V/O; LR TKO o Titration of V fluids to patient s mentation is recommended o 70mmHg + (age in years x2) systolic ARAMC ain Management (edi Medical 14) TCO2 monitoring (rocedure 7) ALRTS: Manage ABC s prior to injury stabilization Any patient with ON Red or TWO Blue is a Alert Long Spine Boards can be used to splint multiple extremity fractures Always remember that traumatic injuries may have been precipitated by a medical event. roper evaluation and assessments are necessary on all trauma patients to recognize, treat, and/or correct potentially life threatening medical problems Accident or ntentional (Assault)

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17 Multiple System 8 ABC s o Monitor Vital Signs o Support life-threatening problems associated with airway, breathing, and circulation Support airway and provide supplemental Oxygen if Oxygen Saturation by pulse oximetry is less than 94% o No gag reflex consider the insertion of the King Airway (rocedure 4) Follow Selective Spinal mmobilization (rocedure 20/20A) TCO2 monitoring (rocedure 7) nsure that a blood glucose reading is obtained, refer to iabetic mergencies (edi Medical 5) valuate for edi Alert Criteria (A 23) atient meets edi Alert Criteria, activate Air Medical (A 1) Treat all life threating injuries appropriately 12 Lead CG, if possible and transmit NTRMAT nitiate V/O; LR TKO o f patient is hypotensive, maintain systolic B at 90mm/hg o 20 ml/kg fluid bolus needed to maintain or restore perfusion Maximum total of 3 boluses ARAMC Tension neumothorax suspected perform Chest ecompression (rocedure 3) ain Management (edi Medical 14) TXA (Rx: 33) NOT For atients < 15 years of age (A 24) Continued

18 Multiple System 8 ALRTS: Manage ABC s prior to injury stabilization Any patient with ON Red or TWO Blue is a Alert (A 23) atients less than 15 years of age should be transported to a Children s Center Long Spine Boards can be used to splint multiple extremity fractures Always remember that traumatic injuries may have been precipitated by a medical event. roper evaluation and assessments are necessary on all trauma patients to recognize, treat, and/or correct potentially life threatening medical problems

19 tic Brain njury (TB) ABC s o Monitor Vital Signs o Support life-threatening problems associated with airway, breathing, and circulation Support airway and provide supplemental Oxygen if Oxygen Saturation by pulse oximetry is less than 94% o No gag reflex consider the insertion of the King Airway (rocedure 4) TCO2 monitoring (rocedure 7) Spinal Motion Restriction (if indicated) (rocedure 20/20A) o levate head degrees to help reduce intracranial swelling GCS of < 8 and one more of the following signs of brain herniation is present, ventilate the patient at a rate of 20 Breaths per Minute o Seizure / Convulsions (edi Medical 18) o upils that are fixed or asymmetric (unequal) o Abnormal flexion or extension (posturing) o Hypertension and bradycardia (Cushing s Syndrome) o ntermittent apnea (periodic breathing) valuate for edi Alert Criteria (A 23) atient meets edi Alert Criteria, activate Air Medical (A 1) nsure that a blood glucose reading is obtained and recorded 9 NTRMAT nitiate V/O; NS o 20ml/kg fluid bolus, maintain systolic B at 90mm/hg o Maximum total of 3 boluses Advanced Airway procedures as needed Continued

20 tic Brain njury (TB) ARAMC 9 Combative & Violent atients (edi Medical 4) Attach CG monitor Advanced Airway procedures as needed o O NOT perform Nasotracheal ntubation in patients with maxialfacial trauma or evidence of a basilar skull injury Monitor for Seizure / Convulsions (edi Medical 18) if present treat with Versed (Rx: 36) o ntranasal 0.2 mg/kg 5 mg MAX repeat every 5 minutes o ntravenous 0.1 mg/kg V/O Max single dose 2 mg Repeat once in 5 minutes ALRTS: When treating a patient with a suspected head injury, it is important to find a balance between providing effective brain perfusion (delivering oxygenated blood to the brain) and not allowing for an increase in intracranial pressure (C). CO2 is a potent vasodilator. As CO2 levels rise, the resulting hypoxia and hypercarbia result in brain tissue swelling and increased C. Studies have shown that when a patient is hyperventilated, the cerebral arteries constrict, decreasing cerebral perfusion. We know that decreasing blood flow to the acutely injured brain is potentially harmful and increases mortality. n order to ventilate patients in a manner that mitigates rises in C, but still provides generous oxygenation of brain tissue (very, very important in early traumatic brain injury), it is critical that we pay close attention to our ventilatory rates. The adult patient with suspected head injury should be ventilated at 16 breaths per minute. The pediatric patient with suspected head injury should be ventilated 25% above the recommended ventilatory rate. f TCO2 is available, ventilation should be targeted at keeping the TCO2 range between mmhg

21 tic Brain njury (TB) 9 As C rises, the brain has nowhere to go except to herniate (push through) the tentorium and/or foramen magnum. The chances of patient recovery or survival decrease significantly when cerebral herniation begins. f signs and symptoms of herniation are present, immediate hyperventilation at breaths per minute is indicated. f TCO2 is available, an TCO2 of mmhg is desirable. The theory is that hyperventilation will rapidly drop the CO2 which results in a constriction of the blood vessels, decreased blood flow to the brain, thereby reducing C Field evaluation of the seriousness of head injury patients requires a constant evaluation of level of consciousness and vital signs to see if your patient s condition is improving or declining solated injury is not an etiology for shock and V fluids should be reserved for evidence of hypovolemia Look for Cushing s Triad (hypertension-widening of pulse pressure, bradycardia, and irregular respirations) which could indicate herniation

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