Teresa Hunt RN, BSN University of Central Florida For University of Rhode Island : NUR433 EMERGENCY CARE

 Infant:  Cry = stress parents, many indications  Very little tolerance for physical or emotional pain or discomfort  Parent – infant bond  Toddler:  Aware of self = autonomous and distinct beings  Restraining and securing = vulnerability  Preschooler:  Fear and fantasy = reduce lag time  Increasing independence = reduced separation anxiety  School-Age:  Risk-taking behavior  Adequate coping and understanding  Adolescent:  Own unique identity  Believe of being invisible, age of extremes GROWTH AND DEVELOPMENT ISSUES

Primary  ABCDEs  Airway  Breathing  Circulation  LOC (Disability)  Exposure Secondary  Full set of Vital Signs  Family presence  Give Comfort Measures  Head-to-toe assessment  SAMPLE  Complete medical history  Inspection of the back TRIAGE & ASSESSMENT

 Infant:  30:2 one rescuer  15:2 two rescuers  Two fingers/thumbs encircling chest  Child:  Same as infant  Heel of one hand or two hands  Adults:  30:2 one or two rescuers  Heel of two hands  /heart-health/life- saving-skills/hands- only-cpr.aspx /heart-health/life- saving-skills/hands- only-cpr.aspx  (adult)  lDZfzU lDZfzU  (Kids) CARDIOPULMONARY RESUSCITATION

 Most common causes:  Hemorrhage, burns and dehydration  Compensation  Increase peripheral vascular resistance, stroke volume, and heart rate. The body also redistributes the blood flow to the vital organs.  If untreated:  Altered sensorium, oliguria, lethargy, confusion, dry mucus membranes, depressed fontanel, cold/clammy skin, poor skin turgor, delayed cap refill, tissue and organ damage (can be irreversible), death.  Treament:  IV crystalloid infusion of warm saline or LR, blood transfusion, Albumin (if needed after bolus) HYPOVOLEMIC SHOCK

 Abnormality in the distribution of blood flow or inability of the body to maintain vascular tone through vasoconstriction.  Signs and Symptoms  Early: Vasodilation, Extremities are warm to touch, Tachycardia, Tachypenia.  Late: Rapid/Thready pulse, cyanosis, cold/clammy skin, purpuric skin lesions, narrow pulse pressure, oliguria or anuria  Most common cause:  Sepsis (bacteria, viruses, fungi or rickettsiae), Anaphylaxis, central nervous system or spinal injury, and drug intoxication.  Treatment:  IV antibiotics, Steroids, Hypoglycemic and electrolyte correction, vasoconstrictors, blood products, stabilize nervous system/spinal injury. DISTRIBUTIVE SHOCK

 Myocardial function is impaired and cardiac output is not sufficient to meet the body’s metabolic demands.  Signs & Symptoms:  Low cardiac output, cyanosis, respiratory distress, differentiated extremity blood pressures, poor tissue perfusion, and poor response to fluid resuscitation.  Causes:  Structural abnormalities, cardiomyopathies, intractable arrhythmias, trauma, ischemia, metabolic abnormalities, drug intoxication, and impaired cardiac function after intra- cardiac surgical repair  Treatment:  Identify the cause. Then treat with Dopampine, Dobutamine, milrinone, furosemide (Lasix) 1mg/kg, Extracorporeal life support (ECLS), oxygen supply CARDIOGENIC SHOCK

 Blunt Force:  Motor Vehicle Accident  Pedestrian Injury  Penetrating Force:  Stabbing, firearms, blasting and impaling.  20% of pediatric injuries. TRAUMA: BLUNT AND PENETRATING

 Motorcycle accident, trauma eval.  U-TAQs U-TAQs MANAGE TRAUMA PATIENT

 Can cause Permanente damage.  Do not place chemicals in drinking bottles.  90% occur in the home. Over half occur in children <6yrs old. OVERDOSE & INGESTION

Tylenol/Acetaminophen  Signs and Symptoms  1 st : (24hrs) Nausea, vomiting, sweating, pallor, weakness  2 nd : (24-48h) Increase in liver enzymes and bilirubin, RUQ pain, prolonged PTT  3 rd : (3-7 D) Jaundice, liver necrosis, hepatic failure  4 th : (5-7 D) recovery or progression to death.  Treatment  IV fluids, Mucomyst (N- acetylcysteine), 1-2 hrs activated charcoal Aspirin/Salicylates  Signs and Symptoms  1 st : stimulation of respiratory center, leading to repirstory alkalosis.  2 nd : decreased K+, Increase metabolic rate, accumilation of ketones leading to metabolic acidosis, hypokalemia and dehydration, increased PTT, decreased platelet leves  Treatment:  Activated charcoal, IV fluids, Sodium Bicarbonate, Postassium replacement, Vitamin K, Glucose, Hemodialysis COMMON OVERDOSES IN KIDS

Carbon Monoxide  Signs and Symptoms  Headache, visual disturbances, altered LOC, cherry red lips and cheeks, N/V  Treatment  100% oxygen by rebreather mask, Serum carboxyhemoglobin levels, Hypebaric chamber (PRN) Lead  Signs and Symptoms  Dependent on exposure and length of exposure  Treatment  Based on exposure. OVERDOSE IN KIDS

 Submersion that results in asphyxia and death within 24 hrs.  2 nd & 3 rd unintentional deaths in children 1-4yrs old.  Can happen in any body of water including toilets, tubs, ponds, rivers, ect.  Prognosis base on:  Age, submersion time, water temperature, elapsed time before CPR started, neurological status. NEAR DROWNING (SUBMERSION)

 Human bites higher incidence of infection.  Spider bites are the brown recluse spider and the black widow: cause skin necrosis.  Most animal bites are from dogs.  Snakes: poisonous were Crotalids/Pit Vipers and Elapids BITES (HUMAN & ANIMALS)

 Treatment  Depends on origin of the bit such as human, snake, spider or animal.  Animal: irrigation and debridement. Extremity in the dependent position to reduce circulation issues. Identification of creature for antivenin, Possible antibiotics, hypothermic treatment reduce spread BITES: TREATMENT

Nursing Education Consultants, INC. (2007b). Heat exhaustion. Retrieved from mptomsofexhau stion.net HEAT EXHAUSTION

Nursing Education Consultants, INC. (2007a). Heat stroke. Retrieved from ndout.com/pho to/heat-stroke HEAT STROKE

 Daily Mail Reporter. (2011). Boy, three, left with horrific facial injuries as Labrador savages him while his mother strokes puppy. Retrieved from horrific-facial-injuries-Labrador-savages-Poole-Harbour.html  Forsythe, M. (2014). Blunt trauma. Retrieved from  Mishra, B. (2008). Abdominothoracic trauma due to impalement by an iron bar. Retrieve from  Nursing Education Consultants, INC. (2007a). Heat stroke. Retrieved from  Nursing Education Consultants, INC. (2007b). Heat exhaustion. Retrieved from REFERENCES