welcome! [] · . summing all up you now know which which problems can occur from an altered mental...

© www.notfallmedizin.

Welcome!


Pediatric Emergencies

Welcome

to the course:

Children

First Aid


Organizational Issues

• Duration: 2 days, each lasting 3 h 15 min

• We will regularly take short brakes

• After a brake, please return to class in time

• Please set your cell phones in silent mode

or keep them switched off


Course Objectives

Look

Think

Act


Age Groups

Newborns and Infants: Birth to 1 year

Toddlers and Preschoolers: 1 to 5 years

School age: 6 to 13 years

Adolescents: 14 to 18 years



• Children are not young adults!

• Children can rarely determine the exact

location of pain

• Children cannot compensate for

dehydration as easily as adults

Risk of shock!



Children...

• have a strong emotional bond to their

environment

• display a faster and better healing process

than adults and

• rarely suffer cardiac arrhythmia or cardiac

arrest


Chain of Survival

Any chain is only as strong

as its weakest link!


Case Example


Emergency Call

From cell phones or landline telephones

dial:

112

• in any GSM network

• also when abroad

• free of charge

• without PIN code


Emergency Call

To professionally call for help, you should

know the standard „reporting scheme“. Be

prepared to answer.


Emergency Call

Where did it happen?

• Street name and house number

• Part of the building / floor number

• Highway number / road name, together with

reference point in km and direction of driving

• Platform / track number / entrance site

• Best approach via … Street


Emergency Call

What happened?

For Example:

• Person fallen

• Poisoning

• Electric shock


Emergency Call

Which kind of illness / injuries are there?

For example:

• Severely bleeding wounds?

• Difficulty breathing / blue coloration of the

skin?

• Serious chest pain?

• Unresponsive person?

• Patient is a newborn / infant?


Emergency Call

How many patients are involved?

For example:

• Accident with several vehicles

• Children on the rear seat

• Suspected poisoning of several persons after

mushroom dish

• Shock patients that were overlooked at first sight


Emergency Call

Wait for further questions!

• Please hang up on request only

• Leave your phone numver for a call-back

(cell phone)


Reporting an Emergency


Poisoning


Poisoning

Causes:

• Confusion

• Curiosity

• Ignorance


Poisoning

Possible substances:

• Drugs

• Cigarettes

• Cleaning agents

• Plants / Fruits

• Animals


Ways of Intake


Signs and Symptoms

• Nausea, vomiting, diarrhea

• Stomach pain, headache, dizziness

• Agitation, shock

• Rapid or slowed pulse, cardiac arrest

• Low responsiveness to unconsciousness

• Trouble breathing to apnea


Poisoning

Gefahren:

•Mund – Speiseröhre –

Magen/Darm - Blut

•Atemwege – Lunge –

Blut

Immediate consequences:Shock

Unconsciousness

Respiratory arrest

Cardiac arrest

Secondary damage:

Brain – Liver - Kidney


Chemicals

• Household cleaners

• Nail polish remover

• Sprays

• Hand and body lotions

• Nail polish

• Toothpaste


Chemicals

• Acids and bases

• Surfactants

• Nitrogen, phosphate, potassium

• Plant extracts

• Alcohol

• Benzines, keronsene, oils


Chemicals

Interventions:

• Do not provoke vomiting

• Defoamer (for lyes and bases)

• Give tea or water to drink

• No milk!

• Call 112!

• Contact poison control center: (089)19240


Drugs

• Pills

• Nicotine

• Alcohol


Drugs

• Hypnotics

• Antipsychotics

• ASA

• Paracetamol

• Caffeine / nicotine

• Alcohol


Drugs

• Dizziness, fainting, headache

• Dazedness, agitation

• Nausea, vomiting

• Fatigue, unconsciousness

• Difficulty breathing

• Sweating, paleness

• Seizures


Drugs

• Stay calm!

• Call 112!

• Save packing and vomitus

• If unconscious: Recovery position

• Start CPR in case of cardiac arrest



Fruits and Plants

• Rowan berries

• Houseplants

• Garden plants


Fruits and Plants

• Belladonna

• Lily of the Valley

• Foxglove

• Amanita fungi (death caps)

• Fly agaric


Fruits and Plants

• Dry mucous membranes, thirst

• Blurred vision

• Reddened skin

• Fixed, dilated pupils

• Confusion, agitation

• Fatigue

• Difficulty breathing, seizures


Fruits and Plants

• Call 112! (The earlier the doctor arrives,

the better the outcome is)

• Stay calm!

• If unconscious: Recovery position

• Start CPR in case of cardiac arrest



Insects

• Bees

• Wasps

• Midges

• Ticks


Bees and Wasps

• Reddening and swelling around the

puncture site

• Allergic reaction

• Severe swelling of the tongue after sting in

the oral cavity

• Airway obstruction

• Risk of suffocation


Bees and Wasps

Interventions:

• Do not stick your fingers into the patient's

mouth: Risk of amputation

• Cool thoroughly

• Call 112!


Midges

• Carrier of numerous diseases (regional)

• Various cases of sepsis in 2005

• Itchiness, inflammation of the puncture site


Midges

Protection and Intervention:

• Mosquito net

• Cool thoroughly

• Fenistil® gel


Ticks

• Live near the ground (heights up

to 1.5 m)

• on grasses and bushes

• Ticks do not fall on you, they are wiped off

• Active: spring – late autumn

• Sting often remains unnoticed


Ticks

•Scandinavia

•Baltic states

•Poland

•Czech Republic

•Hungary

•Austria

•Slovakia

•Croatia

•Switzerland


Ticks

• Approx. 250

cases p.a.

• Approx. every

10th tick is

infected


Ticks

Protection:

• Cover yourself fully in clothing

• Avoid tall grass, bushes and brushwood

• Use insect repellents (Autan Family)

• Check your body after outdoor trips

• Get vaccinated


Ticks

How to remove ticks:

• Place tweezers on the skin, as low as

possible under the tick

• Pull out slowly

• Caution: Do not crush!

• Alternatively: e.g. TICKNER®


Ticks

Carrier for:

• Lyme borreliosis

• Tick-borne meningoencephalitis

(TBE/FSME)


Break

10 minutes


Heat - Cold


Heat Exhaustion

Cause:

• Physical exercise under elevated ambient

temperatures


Heat Exhaustion

Results:

• Increased perspiration

• Loss of water and electrolytes

• Failure of the circulatory system

• Fainting

• Shock


Heat Exhaustion

Signs and Symptoms:

• Rapid, weak pulse

• Patient feels cold

• Faintness

• Pale, moist and cool skin

• Shock


Heat Exhaustion

Dangers:

• Syncope / Unconsciousness

• Hypothermia through moisture of sweat

• Cardiac arrhythmia


Heat Exhaustion

Interventions:

• Keep patient warm

• Position

• Give something to drink

• Quiet


Heat Stroke

Cause:

• Environmental conditions (hot and humid)

• Inadequate clothing

• Untreated heat exhaustion (e.g.

amphetamines)


Heat Stroke

Result:

• Hypothermia

• Cerebral edema

• Unconsciousness


Heat Stroke

Signs and Symptoms:

• Red head

• Fever

• Dull expression

• Apathy


Heat Stroke

Interventions:

• Loosen or remove clothing

• Cool thoroughly (moist towels / leg

compress)

• Bring the patient's upper body in an

elevated position


Sunstroke

Cause:

• Exposure of the (unprotected) head to

infrared radiation of sunlight


Sunstroke

Signs and Symptoms:

• Red head

• Body temperature (initially) normal

• Possible sunburn

• Possible meningism


Sunstroke

Dangers:

• Elevated intracranial pressure

• Unconsciousness

• Cerebral edema


Sunstroke

Interventions:

• Cool the patient's head

• Bring the patient's upper body in an

elevated position

• Call 112!


Hypothermia

Danger:

„Rewarming Collapse“

Warm blood from the

body's core is mixed

with still cold blood from

the extremities.


Hypothermia

Interventions:

• No passive movement

• Protect against further cooling (blanket)

• Give warm drinks (tea)

• No alcohol


Burns

What to do asfirst aiders?

• Look

• Think

• Act

• Call 112


Burns

1st degree 2nd degree 3rd degree


Cause of Burns

Contact of body parts with hot

materials as:

• Solids (e.g. cooking plate)

• Liquids (e.g. hot water)

• Gases (e.g. fire)

• as well as electricity or radiation


Results

Shock can be caused by:

Pain

Loss of fluids

Shift in fluids


Results

(Multiple) organ failure (MOF)

Released tissue proteins and destroyed

blood components induce an insufficient

perfusion of vital organ systems (kidney,

liver...)


Results

Infection

In severe burns, the protective qualities of

the skin are restricted.

Infectious germs can penetrate through the

impaired skin.


Interventions

Stop thermal exposure

• Move the patient out of the danger zone

• Extinguish burning clothes, leave rests of

clothing on the skin (fire blanket, roll the

patient on the floor)

• Remove scalded clothing


Interventions

Cool affected areas

• with tepid water (until pain is relieved, at

least 10 minutes)


Interventions

Protect the damaged skin

• Cover the wound with a sterile dressing

(sterile gauze dressing for burns)

• No household remedies

(ointments, powder, honey...)


Interventions

Treat shock

• Trendelenburg position if indicated

Prevent heat loss

• Loosely cover the patient in a rescue

blanket

• If necessary build a „tunnel“


Burn Gauze Dressing


Summing all Up

Remove patient from danger zone

Extinguish burning clothes

Cool thoroughly with water

Dress wounds with sterile gauze

Check the patient's vital signs

Call 112


SIDS

Sudden Infant Death Syndrome

• Occurs suddenly without warning

• Predominantly between the 2nd and 6th

month after birth

• The cause of death cannot be clearly

determined

• Between 1,000 and 1,500 cases per year


SIDS

Risk factors:

• Smoking and drinking alcohol during

pregnancy

• Premature delivery and low birth weight

• Smoking in the presence of the child

• Sleeping together with parents in one bed

• Elevated room temperature

• Bed mattress out of natural fibres

(especially coconut)


SIDS

Possible causes:

• Prolonged sleep apnea

• Immaturity of certain brainstem areas


SIDS

Interventions:

• Observation in case of known risk factors

• Resuscitation


Emergency


Background

Our most important

„feedstock“ is oxygen.

Together with the ambient

air, oxygen is inhaled into

the lungs where it is

absorbed by our blood.


Background

The oxygen-enriched blood is then transported via the cardiovascular system to any body cell.

At the same time, carbon dioxide (CO2) is given off as exhaust gas.


Background

The brain controls all

vital processes within

the body (vital signs).

If the mental status of a

patient is altered, vital

reflexes can be absent

(such as breathing).


Consciousness

• Ability of sensual perception

• Ability to think, remember and react

• Ability to orientate yourself

• Ability to perform controlled movement

(locomotion)


Altered Mental Status

Examples:

• Blow on the head

• Sunstroke

• Poisoning

• Low blood glucose

Possible consequence:Unconsciousness



Increased pressure on the brain or intracranial bleeding can cause unconsciousness, resulting in absent protective reflexes.



The patient's tongue slides backwards and obstructs the windpipe. In addition, vomitus can flow freely into airway.



Breathing is impeded:

Possible consequence:

Suffocation by choking

ones's own tongue or

stomach contents.



Without breathing

adequately, the heart

muscle receives not

enough oxygen.

Consequence:

Cardiac arrest



Without blood flow, the

brain receives not

enough oxygen.

Consequence:

Brain death sets in after

3 to 5 minutes.


Respiratory Distress

Examples:

• Irritant gas inhalation

• Asthma attack

• Chest pain injury

• Airway obstruction

Consequences:DyspneaApnea


Respiratory Distress

Without adequate

respiration, the brain

receives not enough

oxygen.

Consequence:

Unconsciousness

Diminished protective

reflexes

Suffocation

Death


Cardiovascular Disorders

Examples:

• Severe bleeding

• Electric shock

• Poisoning

Consequences:Insufficient cerebral perfusionUnconsciousness


Cardiovascular Disorders

By now, you already

know the further

progress.

Without consciousness

the patient is in danger

of suffocating.

Without breathing: No

heart activity

Without a heartbeat:

Death


Emergency

There are many

different illnesses and

injuries...

...but only few causes of

death!


Your Responsibility


Risk of Aspiration

Examine the oral cavity before opening the airway!


Head-tilt, Chin-lift Method

This procedure secures an open airway and

allows you to check for respiration:


Head-tilt, Chin-lift Method

With a slight movement to

the head, you can prevent

the tongue from blocking

the unconscious patient's

windpipe.

First aid is easy – be

confident!


„Sniffing Position“

In children up to 2 years

the head should be

brought into a neutral

„sniffing position“.

• Look

• Listen

• Feel


Summing all Up

You now know which which problems can

occur from an altered mental status.

It will be your task to quickly recognize the

unconscious patient and to make up for

missing protective reflexives.

Without treatment, the unconscious patient

will inevitably die from suffocation – it is only

a matter of time!


Recovery Position


Recovery Position

• Place the infant on a hard surface in a

supine position, the head turned

towards one side.

• Check the vital signs regularly.


Evaluation Scheme

Responsive Unresponsive

Render help as situation requires

Breathing absent

Check for breathing

Recovery Position

Repeatedly check the patient's vital signs

Set painful stimulus

Breathing normally

Talk / Touch

Initiate CPR


Ventilations in Infants


Ventilation in Children


Artificial Ventilation


Chest Compressions


Chest Compressions

• Apply pressure to the sternum, using 2 fingers

• Compressions should be 2 – 3cm in depth

• Each compression 1 – 2cm in depth


Chest Compressions

• Use one hand only

• Compressions should be 2 – 3cm in depth

• Approx. 100 compressions per minute


CPR Rhythm


CPR Guidelines


Exercises

Time to practice...


Airway Obstruction

• Peanut

• Dice

• Toy blocks

• Small objects


Airway Obstruction

• If an object is

visible, clear the

airway

• Provoke coughing

by a distinct blow

between the

shoulder blades


Provoke Coughing


Croup Syndrome

• Age: 6 months to 3

years old

• Starts out gradually

• Location: Vocal

cords and below

• Viral infection


Croup Syndrome

Signs and Symptoms:

• Hoarse voice

• Nasal flaring, mouth closed

• High-pitched sound during inspiration and

expiration

• Barking cough

• Almost no fever


Croup Syndrome

Interventions:

• Arrange a quiet environment, give comfort

• Supply with moist air

• Ensure contact to one parent

• Call 112 and refer to hospital


Epiglottitis

• Age: 2 – 6 years

• Acute onset without

warning

• Location: Epiglottis

• Caused by bacteria

• Life-threatening!

• Hib vaccination recommended

(Haemophilus influenzae type B)


Epiglottitis

Signs and Symptoms:

• Quiet, high-pitched sound during inspiration

• Mouth open, difficulties swallowing, drooling

• Child talks little and with unclear speech

• Sitting position

• High fever

• Very ill, reticent and anxious expression


Epiglottitis

Interventions:

• Stay calm

• Have the child sit upright (never lie down!)

• Do not examine or palpate the oral cavity

• Supply with fresh air

• Call 112 immediately,

for this is a life-threatening condition!


Bone Fractures


Bayonet Position


Bone Fractures


Bone Fractures

Immobilization of the lower extremities


Bone Fractures

• Immobilize, for example by padding

• If indicated apply a splint, for example

using a newspaper

• Do not apply pressure, do not try to reduce

a misalignment

• If bandage is necessary, wrap it loosely

• Preventive measures: Give them calcium

and let them romp!


Lacerations


Bite Wounds


Adhesive Plaster


Wound Dressing


Pressure Dressing


Wounds


Knocked out Teeth

• Consider replantation by a surgeon to

avoid misalignment of newly grown teeth

• How to store:

- Older children should, at best, keep them

in their mouths

- In case of infants, keep the broken teeth

in milk

Do not touch a tooth at its root!


Your Home Medicine Chest

• Thermometer

• Adhesive plaster

• Tick tweezers

• Ice or coolpacks

• Safety pin


Your Home Medicine Chest

• Activated charcoal (e.g. Kohle-Pulvis®)

• Defoaming agent (e.g. Sab Simplex®,

Espumisan®)

• Medication for known illnesses and

allergies


„Kinder und Gift“

Guidebook about children

and poisons:

• How to prevent poisoning

• How to recognize poisoning

• Rules of practice

• First aid

• Dangerous substances

• Poison control centers


„EH am Kind“

Guidebook about children first

aid:

• Recommendations to various

emergencies

• Summary of most important

measures

• You can download this brochure

free of charge at:


www.notfallmedizin.de


Questions & Suggestions

Do you have any further questions?

You will find more information here:

At this address, you are also invited to leave praise and reprimand concerning your course or teacher.


The End

Thank you for your attention!

welcome! [] · . summing all up you now know which which problems can occur from an altered mental...

Documents