Children taught to avoid bees

1. Children taught to avoid bees • Those sensitized & demonstrate life-threatening systemic response, SQ admin epinephrine STAT • Hypersensitive children; kit with epinephrine, syringe, & antihistamine preparation. • Wear medic alert bracelet • Someone at school, if not nurse, should be designated to administer if need be • Parents responsible to ensure expiration date current & replace an outdated one

2. Severe allergic reaction Swelling of airway, lips, face Risk for: airway obstruction Tx: Epipen Anaphylaxis

3. West Nile Virus • Mosquito transmitted –flavivirus • S&S incubation – 3-15 days • Most mild flu like ie fever, h/a, body aches • Rash swollen lymph glands • Elderly & young children most at risk • Those with impaired immune systems • May result in meningitis or encephalitis • Treatment • No treatment, medication or vaccine • Prevention • Reduce exposure, DEET, control mosquito population

4. Deet – bug repellents • Effective for variety of insects • Protection from 1- several hours • Reapply if wet • Adverse effects • See recommendations for use from Health Canada

5. Bites/Stings (see p 776-777) • Prevention – protective clothing • DEET(diethyltoluamide) –best repellent • Follow label instructions -> reapply after swimming, sweating, throughout day • NB – side effects have been reported in young children .˙. long term effects of DEET are unknown caution against use of high concentrations of DEET and excessive application • Do not apply DEET to childrens’ hands d/t risk of contact with eyes • Remove DEET with soap & water when child is brought indoors

6. Snake bites – tourniquet, suction • Transport snake with victim • Animal Bites • Risk for infection,

7. Animal bite - first aid • Did you know.... • Rabies is 100% preventable, yet results in over 55,000 human deaths each year. • Rabies is present throughout the world. • The greatest number of human deaths occur in Asia and Africa where canine (dog) rabies is common.

8. Animal bite - first aid - series: • Procedure, part 1 Procedure, part 2 If the bite is actively bleeding, apply direct pressure with a clean, dry cloth until the bleeding subsides. Elevate the area of the bite. If the bite is on the hand or fingers, call the doctor right away. Over the next 24 to 48 hours, observe the bite for signs of infection (increasing skin redness, swelling, and pain). If the bite becomes infected, call the doctor or take the person to an emergency facility.

9. Rabies • An acute infection of the CNS • Caused by virus transmitted by saliva of infected animal • Virus multiplies in muscles and fatal if untreated • Highest incidence in humans is in children younger than 15 years

10. Rabies (cont.) • 12% of cases come from domestic animals, especially cats • Infected wild animals are most commonly raccoons, skunks, foxes, and bats • Unprovoked attack is more likely to indicate a rabid animal than a provoked attack • Antirabies protocol/shots started immediately

11. Rabies • An acute viral infection is transmitted to humans by a bite or by the exposure of broken skin to an infected animal's saliva • Immunization given early (preferably within 24 hours but certainly within 72 hours) can usually prevent the disease.

12. Epistaxis • Nosebleed or hemorrhage from the nose • Pathophysiology & Etiology • Local causes • Systemic causes • Most are anterior; posterior bleeds are more difficult to control • Management • Sit up & lean forward (not lie down) • Apply continuous pressure with thumb & forefinger > 10 min • Cotton pledget/wadded tissue into ea nostril & apply ice or cold cloth to bridge of nose • Keep calm & quiet

13. pinch the entire soft part of the nose closed for 15 minutes. The nosebleed should stop. If a nosebleed doesn't stop with pinching, blow out all the blood. Now spray several times into the bleeding nostril with a nasal decongestant spray. Again hold the entire soft part of the nose shut for 15 minutes. A cold-pack may slow the bleeding, but shouldn't interfere with pinching the nose

14. After the nosebleed stops, rest for a half hour. Leave your nose completely alone. Resist the temptation to wipe the clots out and blow the nose. Once things settle down, put a little lubricating gel or ointment just inside the nostril. ointment should be applied very gently, only about 1 cm inside the nostril. Repeat twice a day for a week.

15. Foreign Bodies Nasal • Food, beans, crayon pieces, paper, etc. • Leads to irritation, infection, obstruction • Foul-smelling nasal discharge, difficulty breathing, discomfort • Do NOT probe nose or try to remove if not visible • Have child blow gently through affected nostril

16. Foreign Body Aspiration • Choking = implementation of i)back blows ii) heimlick maneuver (CPR certification. Also refer to figs 31-25 & 31.26) • S&S of distress • Cannot speak child is truly choking • Becomes cyanoic STAT intervention • Collapses can die within 4 min • Follow-up care after foreign body removed: includes monitoring for resp distress, HT parents

18. Ear • Do NOT attempt to remove by probing with swab • Do NOT reach into ear with tweezers Prevention • Keep small objects out of reach of infants and toddlers • Discourage children from putting things in body openings

19. Hypoglycemia • Imbalances of food intake, insulin & activity • Gastroenteritis, N&V, excitement, exercise • S&S similar for hypo & hyper • Weakness, dizziness, headache, dwosiness, loss of coordination, • If in doubt treat as hypo • Best to do stat blood sugar to guide treatment Prolonged- seizures, coma & possible death

20. Emergency Treatment of Hypoglycemia • Mild Reaction: • simple carb must be followed up by protein • Milk or fruit juice • Insta-glucose, sugar cubes • Moderate Reaction: • administer 15 g carbs, simple carb and 125mL OJ; recheck BS q5min, readminster OJ if pt still alert & able to swallow • If pt altered LOC, administer glucagon if no IV access

21. Emergency Treatment of Hypoglycemia • Severe Reaction • Unresponsive: IV access with 1 amp Dextrose 50% • Insulin reaction • Drowsiness- unresponsive, sweating, tachycardia • 50% glucose IV • Glucagon – watch for vomiting post injection • DKA • life threatening, requires ICU monitoring

22. Hypoglycemia Behavioural changes, confusion, slurred speech, belligerence Diaphoresis Tremours Palpitations, tachycardia Hyperglycemia Mental status changes, fatigue, weakness Dry, flushed skin Blurred vision Abdominal cramping, nausea, vomiting, fruity breath odour DiabetesHypoglycemica vs hyperglycemia

23. Near Drowning • Prognosis is best if the water is cool and the victim is immersed for less than 5 minutes • 90% occur in swimming pools • Boys 5:1 • 50% occur under age 4 years

24. Pathology- Near Drowning • Laryngospasm & aspiration • Cardiopulmonary arrest after 4-6 minutes • Hypoxia causes cellular damage—brain after 4-6 minutes; heart and lungs after 30 minutes = Most organ systems affected • Pulmonary edema, atelectasis, airway spasm, pneumonitis • All children should be hospitalized for 12-48 hrs even in near-drowning

25. Management – Near Drowning • ICU-Respiratory assessments, V/S, mechanical ventilation and/or tracheostomy, blood gases, chest therapy, IV therapy • Emotional support for family • If no purposeful movement within 24 hours = severe neurological damage or death

26. Nursing Care • V/S, respiratory assessment, close observation • O2 administration. May need mechanical ventilation • Fluids need strict monitoring to avoid pulmonary edema

27. Pediatric CPR • Arrest most often r/t prolonged hypoxemia • Causes – • Respiratory arrest better survival rate (87 %) than cardiac (25%) • In hospital be familiar with emergency equipment (see p 1335- 1341) • Transport by EMS preferred if in community

28. When to transfer a camper off site • Class discussion

29. THE END • FINISHED • COMPLETED • OVER • Done • This is it !!!! • Now onto 5th semester !!!