ENPC

1. TIPS ENPC SPINE BRAIN

2. ENPC TIPS Dope D: Dislodgement O: Obstruction P: Pneumothorax E: Equipment Failure P: PAIN P: Pallor P: Pulse P: Paralysis P: Paresthesia M: Mechanism Of Injury I: Injuries Sustained V: Vital Signs T: Treatment Primary Survey A B C D E Secondary Survey F G H I

3. ENPC TIPS Dope D: Dislodgement O: Obstruction P: Pneumothorax E: Equipment Failure P: PAIN P: Pallor P: Pulse P: Paralysis P: Paresthesia 2 x age + 8= wt/kg EPI 0.01mg/kg 1:10000 M: Mechanism Of Injury I: Injuries Sustained V: Vital Signs T: Treatment 16+ age 4

4. ENPC TIPS Neurovascular Assessment The 5 P’s P: Pallor P: Pulse P: Pain P: Paresthesia P: Paralysis M: Mechanism of Injury I: Injuries Sustained V: Vital Signs T: Treatment DOPE D:Dislodgement O: Obstruction P: Pneumothorax E: Equipment Failure Neurological Assessment AVPU A: Awake & Alert V: Verbal Stimuli only P: Painful Stimuli only U: Unresponsive

5. Pediatric Assessment Triangle C: Chief ComplaintI: Immunizations IsolationA: AllergiesM: MedicationsP: Past Medical History Parent’s ImpressionE: EventsD: Diet DiapersS: Symptoms Inspect Auscultate Palpate Triage History Appearance Work of breathing Circulation Emergent Urgent Nonurgent ½ first 8 ½ second 16 2-4 cc/kg x % BSA over 24 hours

14. Pediatric patients need Maintenance fluids too BURN: Fluid Resuscitation Formula 2-4 cc/kg x % BSA over 24 hours ½ in first 8 hours post burn ½ in next 16 hours

15. INITIAL ASSESSMENT PRIMARY ASSESSMENT A AIRWAY B BREATHING C CIRCULATION D DISABILITY EEXPOSE ENVIRONMENTAL CONTROL SECONDARY ASSESSMENT F FULL SET OF VITAL SIGNS FAMILY PRESENCE FIVE INTERVENTIONS G GIVE COMFORT MEASURES H HEAD TO TOE ASSESSMENT HISTORY (CIAMPEDS) I INSPECT POSTERIOR SURFACES

19. Traumatic Brain Injury Primary injuries are those that occur at the time of impact and are a result of direct traumatic forces that injure brain tissue and kill brain cells. Primary injuries occur in a fraction of a second and may be irreversible. Common types of primary injuries include: Concussion Contusion and Laceration Skull fracture Scalp laceration Epidural hematoma Subdural hematoma Subarachnoid hemorrhage Diffuse axonal injury 600,000 yearly treated for head injuries 25,000 yearly die from head injuries 30,000 yearly are left with permanent disabilities Leading cause of acquired disabilities in childhood Age related Risks: Infants: Have large heads in relation to rest of body. Are commonly result of falls over 4 months of age Have involuntary reflexes, such as crawling may propel infants forward unexpectantly Begin to roll from back to abdomen in second month which predisposes fall from heights Motor vehicle crashes are the major source of severe TBI in infants; major cause is: Unrestrained or improperly restrained child Rear facing child seats from birth to 20 pounds or one year of age. Toddler and Preschoolers: Are involved in motor vehicle accidents as passengers and pedestrians. Children who weigh more than 20 pounds and greater than one year should ride forward Until they are 40 pounds or 4 years of age. The most serious head injuries often result from pedestrian-accidents, young thrown onto The hood, windshield or top of vehicle. School-Age Children: Ages 6 to 12 years Are at risk as pedestrians and passengers Operated moving vehicles such as bikes, skateboards, rollerblades. Injuries are decreased substantially by the use of helmets. Mechanism of Injury Relates to the force of impact or inertial forces that result in injury to the scalp, skull or brain tissue. The extent of injury is based on the force and location of impact, rate of energy transfer and surface area.

20. 8 Stages of Development per Erickson Stage 1: Infancy: Birth - 1 year old Trust vs. Mistrust During this stage an infant develops a sense of trust. They build on this level to see how their needs are met. If they are met consistently they develop trust, if not consistently met, they develop a sense of mistrust. Stage 2: The Toddler Period: 1 – 3 years old Autonomy vs. Shame and Doubt If trust has been developed, then the infant will be confident enough to accomplish new skills. They learn from behavior limit setting. They learn to control their impulses. They try to be independent. It is important to promote independence so their autonomy will develop. Toddlers learn by doing. Stage 3: The Preschool Period: 3 – 6 years old Initiative vs. Guilt Preschoolers master developmental tasks and learn new skills. They develop the ability to make decisions. They desire to do for themselves without the help of adults. They learn thru accomplishments. If they do not make accomplishments, then they will be reluctant to act and will develop feelings of guilt Stage 4: The School-Ager: 6 – 12 years old Industry vs. Inferiority This is the age of workers and producers. The need achievement. They learn rules and how to compete and cooperate with others. They need praise and mastery development Stage 5: Adolescence: 12 – 18 years old Identity vs. Role Confusion The search for personal identity is in place. A sense of role confusion and identity crisis emerge during this time. Stage 6: Young Adulthood: 18 – 40 years old Intimacy vs. Isolation Young adults prepare to share meaningful relationships and friendships. During young adulthood interpersonal development occur and self identity flourish. Stage 7: Middle Adulthood: 40 – 65 years old Old Generativity vs. Stagnation Productivity vs. Stagnation are the important components of this development tasks. Stage 8:Older Adult: 65 years + Ego Integrity vs. Despair A sense of purpose is vtally important during these years.

21. AIRWAY VOCALIZATION TONGUE OBSTRUCTION LOOSE TEETH OR FOREIGN OBJECTS VOMITUS, BLEEDING, SECRETIONS EDEMA, DROOLING, DYSPHAGIA PREFERRED POSTURE ABNORMAL AIRWAY SOUNDS INTERVENTIONS INITIATE MANUAL CERVICAL SPINE IMMOBILIZATION OR MAINTAIN SPINE IMMOBILIZATION FOR THE TRAUMA PATIENT ALLOW PATIENT TO MAINTAIN POSITION OF COMFORT OPEN AND CLEAR THE AIRWAY JAW THRUST HEAD TILT CHIN LIFT POSSIBLE PADDING UNDER SHOULDER SUCTION IMMEDIATELY FOR VOMITUS OR OTHERSECRETIONS AIRWAY ADJUNCTS PREPARE FOR ENDOTRACHEAL INTUBATION

22. BREATHING LEVEL OF CONSCIOUSNESS SPONTANEOUS BREATHING RATE AND DEPTH OF RESPIRATION CHEST RISE AND FALL PRESENCE OF BILATERAL BREATH SOUNDS WORK OF BREATHING NASAL FLARING, RETRACTIONS, HEAD BOBBING, ASSESSORY MUSCLE USE JUGULAR VEIN DISTENTION TRACHAEL POSITION PARADOXICAL RESPIRATIONS SOFT TISSUE, BONY CHEST WALL INTEGRITY INTERVENTIONS POSITION PATIENT DELIVER SUPPLEMENTAL OXYGEN ASSIST VENTILATIONS ASSESS EFFECTIVENESS OF VENTILATION LIST INDICATIONS FOR INTUBATION

23. CIRCULATION CENTRAL AND PERIPHERAL PULSE RATE AND QUALITY SKIN COLOR AND TEMPERATURE CAPILLARY REFIL UNCONTROLLED EXTERNAL HEMORRHAGE INTERVENTIONS CONTROL UNCONTROLLED EXTERNAL BLEEDING OBTAIN VASCULAR ACCESS INITIATE INTRAOSSEOUS IF NECESSARY FLUID BOLUS OF 20CC/KG AND REPEAT IF NECESSARY CARDIAC COMPRESSIONS DRUG THERAPY DEFIBRILLATION OR SYNCHRONIZED CARDIOVERSION