emergency splinting and trauma first aid

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!