• 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current & replace an outdated one

Anaphylaxis

• Severe allergic reaction• Swelling of airway, lips, face• Risk for: airway obstruction

• Tx: Epipen

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

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

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

• Snake bites – tourniquet, suction– Transport snake with victim

• Animal Bites– Risk for infection,

• 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.

Animal bite - first aid

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.

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

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

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.

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

A cold-pack may slow the bleeding, but shouldn't interfere with pinching the nose

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.

pinch the entire soft part of the nose closed for 15 minutes. The nosebleed should stop.

ointment should be applied very gently, only about 1 cm inside the nostril. Repeat twice a day for a week.

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.

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

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

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

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

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

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

DiabetesHypoglycemica vs hyperglycemia

• 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

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

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

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

Nursing Care

• V/S, respiratory assessment, close observation

• O2 administration. May need mechanical ventilation

• Fluids need strict monitoring to avoid pulmonary edema

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

When to transfer a camper off site

– Class discussion

THE END

• FINISHED

• COMPLETED

• OVER

• Done

• This is it !!!!

• Now onto 5th semester !!!