This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
The Fundamentals: Anatomy, Physiology, The Fundamentals: Anatomy, Physiology, Disaster SpecificDisaster Specific
Patters of InjuryPatters of Injury
Body Size and CompositionBody Size and Composition
height and weight increase throughout height and weight increase throughout childhoodchildhood
less protective fat and muscleless protective fat and muscle
large surface area predisposes to large surface area predisposes to hypothermiahypothermia
Anatomic DifferencesAnatomic Differences
The youngest children have relatively larger and The youngest children have relatively larger and heavier headsheavier heads
Relatively larger and less protected abdomensRelatively larger and less protected abdomens- Penetrating injuriesPenetrating injuries
- Primary and secondary impact from objects or blast wavePrimary and secondary impact from objects or blast wave
Predisposition to Predisposition to more seriousmore serious traumatic traumatic damage during disasters compared to adult for damage during disasters compared to adult for the same injurythe same injury
Anatomic DifferencesAnatomic Differences
Smaller mass may cause children to be Smaller mass may cause children to be thrown further and faster, resulting in thrown further and faster, resulting in greater secondary injuries upon impactgreater secondary injuries upon impact
Surface to Body RatioSurface to Body Ratio
Higher surface area and thinner skinHigher surface area and thinner skin
Risk of exposure-related injuriesRisk of exposure-related injuries- BurnsBurns
- Hypothermia after decontaminationHypothermia after decontamination
- Toxic exposure to the skinToxic exposure to the skin
Faster Respiratory RateFaster Respiratory Rate- DehydrationDehydration- Ingestion of toxins, smoke, dustIngestion of toxins, smoke, dust
Lower Blood VolumeLower Blood Volume- Shock from bleedingShock from bleeding- Greater risk from dehydrationGreater risk from dehydration
Greater relative metabolic needsGreater relative metabolic needs- Higher risk for malnutrition sooner than adultsHigher risk for malnutrition sooner than adults- ↑ ↑ susceptibility to hypoglycemia? susceptibility to hypoglycemia?
SizeSize
Live Closer to the FloorLive Closer to the Floor- Risk of exposure to debris and waterRisk of exposure to debris and water
- Greater chance of exposure to chemical or Greater chance of exposure to chemical or radioactive residueradioactive residue
- ExampleExample: : Infant contracts cutaneous anthrax on Infant contracts cutaneous anthrax on arm after visiting ABC television studios targeted arm after visiting ABC television studios targeted during the 2001 attackduring the 2001 attack
SizeSize
Hand-to-Mouth ActivityHand-to-Mouth Activity- Children routinely place hands and objects in Children routinely place hands and objects in
mouth, increasing risk of exposure to chemicals, mouth, increasing risk of exposure to chemicals, toxinstoxins
- Increases risk of contracting vomiting and Increases risk of contracting vomiting and diarrheal illness during unsanitary conditions such diarrheal illness during unsanitary conditions such as in a shelter or with exposure to contaminated as in a shelter or with exposure to contaminated water supplywater supply
Immune SystemsImmune Systems
Young children do not have the same Young children do not have the same capacity as adults to respond to capacity as adults to respond to infectious diseaseinfectious disease- Biological agentsBiological agents
- Routine infections during shelteringRoutine infections during sheltering
How Children DecompensateHow Children Decompensate Differently than adultsDifferently than adults
Children rarely have primary cardiac eventChildren rarely have primary cardiac event
Pathway is predictablePathway is predictable- Focus is on respiratory problems and shockFocus is on respiratory problems and shock
- To know it is to prevent decompensationTo know it is to prevent decompensation
- Recognize early signs and symptoms of respiratory Recognize early signs and symptoms of respiratory distress and shockdistress and shock
Pathway to Decompensation
FULL ARREST
DEATH
RESPIRATORY FAILURE
Respiratory DistressDECOMPENSATED
Respiratory DistressCompensated
CIRCULATORY FAILURE
Circulatory DistressDECOMPENSATED
Circulatory DistressCompensated
Many CausesAsthma, ShockFB, Secretions
Toxins, etc.
Body ProportionsBody Proportions
body proportions account for unique injury body proportions account for unique injury patterns in childhoodpatterns in childhood
large head increases risk of head injury large head increases risk of head injury accompanying any other major traumatic accompanying any other major traumatic injury injury
large, “unprotected” intraabdominal organs large, “unprotected” intraabdominal organs increases risk of liver, spleen, bowel injury increases risk of liver, spleen, bowel injury following less severe trauma following less severe trauma
Etiologies of Cardiopulmonary FailureEtiologies of Cardiopulmonary Failure
diaphragm as a respiratory musclediaphragm as a respiratory muscle
Features ofFeatures ofthe Pediatric Cardiovascular Systemthe Pediatric Cardiovascular System
shock: defined as the clinical state of shock: defined as the clinical state of inadequate perfusion to meet metabolic needsinadequate perfusion to meet metabolic needs
Features ofFeatures ofthe Pediatric Cardiovascular Systemthe Pediatric Cardiovascular System
degree of shock is based on evaluation of the degree of shock is based on evaluation of the end organs of perfusion:end organs of perfusion:
- skin (color, temperature, cap refill)skin (color, temperature, cap refill)
Simultaneous Palpation of Proximal Simultaneous Palpation of Proximal and Distal Pulsesand Distal Pulses
Features ofFeatures ofthe Pediatric Cardiovascular Systemthe Pediatric Cardiovascular System
cardiac output is rate dependent: infants cardiac output is rate dependent: infants cannot increase stroke volume to cannot increase stroke volume to compensate for shockcompensate for shock
smaller total blood volume: 80-100cc/kgsmaller total blood volume: 80-100cc/kg
Hemodynamic Changes with Blood Hemodynamic Changes with Blood LossLoss
Pediatric Vital SignsPediatric Vital Signs
mean heart rate decreases with agemean heart rate decreases with age
tachycardia is an early and nonspecific sign of shocktachycardia is an early and nonspecific sign of shock
mean blood pressure increases with agemean blood pressure increases with age
blood pressure is usually normal even in a child with blood pressure is usually normal even in a child with moderate-severe hypoperfusionmoderate-severe hypoperfusion
increased peripheral vascular tone allows for normal increased peripheral vascular tone allows for normal blood pressure until end-stage shock blood pressure until end-stage shock
vital signs not helpful in gauging degree of shock in vital signs not helpful in gauging degree of shock in childrenchildren
Pediatric Cervical SpinePediatric Cervical Spine
fulcrum is at C2-3fulcrum is at C2-3
growth plate of densgrowth plate of dens
weak neck musclesweak neck muscles
large head increases momentum large head increases momentum
SCIWORA because of ligamentous laxity SCIWORA because of ligamentous laxity
most fractures occur at C1-2 most fractures occur at C1-2
difficulty with immobilization: large head/small chest allow difficulty with immobilization: large head/small chest allow for excessive flexion in supine position for excessive flexion in supine position
Head Injury inHead Injury inthe Young Pediatric Patientthe Young Pediatric Patient
skull is more compliant offers less skull is more compliant offers less protection to the brainprotection to the brain
open sutures and fontanelopen sutures and fontanel
mobile middle meningeal arterymobile middle meningeal artery
intracranial bleeds occur without intracranial bleeds occur without accompanying fractureaccompanying fracture
intracranial bleed can cause shockintracranial bleed can cause shock
Localized Head TraumaLocalized Head Trauma AssessmentAssessment
- historyhistory- vital signsvital signs- local findingslocal findings
Treatment GoalsTreatment Goals- prevent secondary brain damageprevent secondary brain damage- maintain good cerebral perfusion pressuremaintain good cerebral perfusion pressure
TreatmentTreatment- control external bleedingcontrol external bleeding- oxygenate & hyperventilate as neededoxygenate & hyperventilate as needed- fluid resuscitate to maintain adequate perfusionfluid resuscitate to maintain adequate perfusion- keep head in midline position and HOB elevated 30 degreeskeep head in midline position and HOB elevated 30 degrees- control seizures if possiblecontrol seizures if possible
Isolated Spinal TraumaIsolated Spinal Trauma
AssessmentAssessment
- history (mechanism, amount of force)history (mechanism, amount of force)
large liver and spleen extend below ribslarge liver and spleen extend below ribs
kidney contains less perinephric fatkidney contains less perinephric fat
gastric distention (with ventilation or gastric distention (with ventilation or crying) can present as a tense abdomencrying) can present as a tense abdomen
Heat stroke Heat stroke - T > 41C, hot skin, severe CNS dysfunction, T > 41C, hot skin, severe CNS dysfunction,
circulatory collapsecirculatory collapse
Treatment of HyperthermiaTreatment of Hyperthermia
Remove clothingRemove clothing
Begin active coolingBegin active cooling
Transport to cool environmentTransport to cool environment
Cardiovascular supportCardiovascular support
Fluid Resuscitation: 20 mg/kg Fluid Resuscitation: 20 mg/kg lactated Ringers or 0.9% sodium lactated Ringers or 0.9% sodium chloridechloride
HypothermiaHypothermia
Assessment & ExamAssessment & Exam
Internal vs. External EtiologiesInternal vs. External Etiologies
Pale or cyanoticPale or cyanotic
Shivering mechanismShivering mechanism
CNS function progressively impaired with CNS function progressively impaired with falling temp. Comatose at approx 27 C.falling temp. Comatose at approx 27 C.
Decreased BP, heart rate, or bothDecreased BP, heart rate, or both
Treatment for HypothermiaTreatment for Hypothermia
to provide guidelines for scene to provide guidelines for scene management , care and management , care and transportation of patients transportation of patients contaminated by radiation or contaminated by radiation or hazardous chemicalshazardous chemicals
General InstructionsGeneral Instructions
Upon discovery of Hazmat scene, notify Upon discovery of Hazmat scene, notify communication center to dispatch Hazmat expertcommunication center to dispatch Hazmat expert
Delay entry until appropriate team and protective Delay entry until appropriate team and protective equipment is availableequipment is available
Expect the Hazmat team to initially remove any Expect the Hazmat team to initially remove any patientspatients
Follow advice of Hazmat team regarding personal Follow advice of Hazmat team regarding personal protection or patient decontaminationprotection or patient decontamination
Additional RulesAdditional Rules
Don’t be a hero...Don’t be a hero...
Always maintain a high index of suspicionAlways maintain a high index of suspicion- Secondary devicesSecondary devices
General Signs and Symptoms of General Signs and Symptoms of Hazmat ExposureHazmat Exposure
Local EffectsLocal Effects-complaints of burning skin, teary eyes, complaints of burning skin, teary eyes,
dry or sore throat, a cough or sneezing.dry or sore throat, a cough or sneezing.
Systemic EffectsSystemic Effects-complaints of difficulty breathing, bizarre complaints of difficulty breathing, bizarre