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Module 9 Caring for Children with Pediatric Emergencies

Learn about the common patterns of pediatric trauma and injuries, including head injuries and near drowning accidents. Discover how to assess and provide initial resuscitation for children in emergency situations. Gain knowledge on child maltreatment, including physical abuse, neglect, and the importance of reporting. Explore the impact of drug and substance abuse on parental caregiving.

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Module 9 Caring for Children with Pediatric Emergencies

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  1. Module 9 Caring for Children with Pediatric Emergencies

  2. Introduction • Trauma is the most common cause of mortality and morbidity in the U.S. pediatric population • Injuries cause more fatalities among children than all disease combined • Head injuries account for the majority of deaths • then thoracic

  3. Statistics • Injury is the leading cause of death among children older than 1 year • excludes neonatal preemie's • Death from unintentional injury accounts for 65% of all injury deaths in children younger than 19 yrs old • 20,000 children die per year

  4. Patterns of Injury • Age • infants and toddler age group, falls are a common cause of severe injury • older children/adolescents, bicycle related mishaps • Environment • home is most common scene of pediatric injury

  5. Initial assessment and resuscitation • ABCDEs of trauma should be followed • Airway - control is first priority • anatomical differences • neck shorter • larynx smaller (size of 5th digit) • shorter trachea • larger tongue • Assume C-spine injury

  6. Near Drowning • Children are helpless in water • usually fall in to water near their home • pleasure boating • fail to wear life preservers • diving accidents • over estimate endurance • in water

  7. SIDS/Apnea/ALTE • SIDS • Unexplained and unexpected death <1yr old • Age • 2-9 months • peak 2-4 months • Clinical Features • death occurs during sleep • no cries or noises of distress

  8. SIDS • Theories • genetic • aspiration • suffocation • CNS • interruption of function • Treatment • support grieving parents • autopsy

  9. Apnea • Interrupted cessation of breathing • may be associated with SIDS or prematurity, reflux, aspiration, sepsis • Diagnosis • cardiopneumogram • Treatment • home apnea monitor • educate parents • time - infant matures

  10. A 32-week gestational infant who had apnea of prematurity is ready for discharge and will be going home on an apnea monitor. What statements indicate additional teaching is needed about the monitor? • The monitor is only for naps or bedtime use • The monitor should be kept on at all times except when bathing • Even though we have a monitor we still need to know CPR • Now that we have a monitor, we don’t have to worry about our baby not breathing • I understand the apnea monitor will alarm if my baby stops breathing

  11. Child Maltreatment

  12. Child abuse Blunt tissue trauma Punched in the mouth Kidney and liver damage Central bruising

  13. Burn Injuries • Milk scalding Boiling water Cigarette lighter

  14. Assess for injury flogging

  15. Line of demarcation

  16. Child Abuse • Be aware of your own feelings • need to be non-judgmental • Incidence • estimated more than 40 per 1000 children are abused 2007 • estimated that 4000 child die annually • Definitions • Physical abuse - is an action by a caretaker that results in non-accidental injury to a child • Physical neglect - act of omission and includes failure to provide adequate food, shelter, clothing, medical care and a safe environment • emotional neglect and abuse • sexual abuse

  17. Assessment - Child - Family - Event • Careful history taking • hx of accident needs to be compatible with type of injury • Observation of the interaction of family members • General appearance of child • Note the location, shape, size, pattern and color of injuries • Photograph injuries

  18. Assessment • Observe the child’s response to authority • Developmental history • especially in neglect • Characteristics of Parents • loners • low self esteem • unrealistic expectations of the child • mental illness • have been abused as a child

  19. Characteristics of Abusive Parents • delays bringing child in for treatment • chief concern of a minor nature • expects the child to meet their emotional needs • no support system

  20. Characteristics of the Abused Child • exhibit behavioral extreme • withdrawal • aggressiveness • temperament • inappropriate maturity • exhibit controlling behaviors • may be wary of adult contact • form only superficial relationships • do not cry with painful procedures • demonstrate poor self-concept

  21. Child Abuse - Physical Indicators • bruises in various stages of healing • welts, object marks • burns • fractures/dislocations • multiple injuries, spiral • lacerations/abrasion • face, torso, back of arms or legs • bite marks

  22. Child Abuse - Physical Indicators • Abdominal Injuries • ruptured liver, spleen, duodenum, pancreas or kidneys • Head Injuries • subdural hematomas, skull fractures, scalp swelling or bald spots, black eyes, retinal hemorrhages

  23. Child Abuse - Environment • Chronic stress • Multiple problems • housing • child spacing • marital problems • Drugs/alcohol

  24. Child Abuse - Incidence • 1/3 of children abused are less than 3 months old • 1/3 are 3 months to 3 years old • 1/3 are 3 years to 6 years old • the greatest incidence is the the non-verbal child

  25. Child Abuse - Legal Reporting • All 50 states have statues that relate to child abuse, neglect or maltreatment • Nurses are required to report actual or suspicion of abuse or neglect • you will sign a legal binding document prior to employment • Failure to report - a misdemeanor with heavy fine

  26. Who reports abuse?

  27. Treat the Family - Altered Parenting

  28. Child Abuse - Overall Goals • Protect child from injury • Provide assistance and support for family members • Eventually reintegrate the family as a functional unit

  29. Drug/Substance Abuse • Alcohol • Most abused drug in our society • Affects most people • Adolescents experiment or use drugs for many reasons • Escape the uncomfortable feelings of daily living • Avoid anxiety related to uncertainty • Insecurity • loneliness

  30. Drug Abuse • Adolescents who abuse drugs are more likely to be: • Depressed • Anxious • Lonely • Feelings of being isolated • Little in common with peers • Negative self image

  31. Drug Abuse • Signs • Change in behavior • Change in grades • Change in friends • Treatment • Look for underlying problem and address that • Family therapy • Teen responsibility for action/behaviors • Look at present difficulties, feelings relationships and their ability to choose

  32. Poisoning • Children will eat or drink anything • parents - need to know the poison control center phone number 1-800-222-1222 • bring substance with you if possible • follow PCC guidelines

  33. Poisoning - Nursing Interventions • ER • assist with neutralization and removal of substance • monitor child • vs • respiratory status • seizure activity

  34. Poisoning - Nursing Interventions • Pediatric Unit • Respiratory System • respiratory depression • Neurologic System • loc • seizures • Eventually teach safety and prevention

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