PREFINALS MCHN

• Toddler Development


  • Gross motor - walking, running, climbing
  • Fine motor - feeding themselves, drawing
  • Sensory/Cognitive - seeing, hearing, tasting, touching, and smelling
  • Language/communication (speech) - saying single words, then sentences
  • Social/Emotional - playing with others, taking turns, doing fantasy play
• Health Problems Common in Toddlers

  • Burns
  • Poisoning
  • Child Abuse
  • Cerebral Palsy
  • Drowning
  • Aspiration
• Electricity


  Can instantaneously destroy tissue
• Burns


  Injuries to body tissue caused by excessive heat greater than 40°C or 104°F
• Burns are the 2nd greatest cause of unintentional injury in 1-4 y.o. and the 3rd most common cause of unintentional injury in children 5 to 14 yo
• Every day, there are more than 300 children treated in emergency rooms for burn-related injuries
• Types of Burns


  • Thermal burns - due to external heat sources eg: Hot metals, scalding liquids, steam, & flames
  • Radiation burns - caused by prolonged exposure to ultraviolet rays of the sun, therapeutic cancer treatments or nuclear power plant leaks
  • Chemical burns - caused by strong acids, alkalis, detergents, or solvents
  • Electrical burns - from electrical current
  • Friction burns - from direct damage to the cells and from the heat generated by friction. eg: falling on or touching a treadmill in motion, rope burn from a rope sliding through the hands
• ASSESSMENT AND MNGMNT


  • Airway
  • Breathing: beware of inhalation and rapid airway compromise
  • Circulation: fluid replacement
  • Disability: compartment syndrome
  • Exposure: percentage area of burn

  
• Compartment syndrome


  Leg swollen, tight, pale, and shiny. Swollen muscle compresses blood vessels and nerves in the leg.

  
• Rule of Nines


  The way medical professionals calculate the TBSA (total body surface area)
• Rule of Nines (Adults)


  • HEAD - 4 1/2%
  • CHEST AND BACK - 9%
  • ARMS - 4 1/2%
  • STOMACH AND BACK - 9%
  • LEGS - 9%
• Lund and Browder Chart is used to calculate TBSA
• Classification and Description of Burns

  • First degree/ Superficial thickness: Affects only the epidermis, or outer layer of skin. Appears red, dry, and with no blisters. Feels mildly painful. Heals 1-10 days by simple regeneration. Common cause: Sunburn
  • Second degree/ Partial thickness: Involves the epidermis and part of the dermis layer of skin. Appears red, blistered, and may be swollen. Very painful. Heals over 2-6 weeks by tissue regeneration. Common cause: Scalding
  • Third degree/ Full thickness: Involves the epidermis and full extent of dermis and may go into the subcutaneous tissue. Appears white or charred and lacks sensation bec. the nerve endings are destroyed. Skin grafting is usually necessary, healing takes months. Scar tissue will cover the final healed site. Common cause: flames
  • Fourth degree: Full thickness burn extending into muscle and bone. Skin grafting is necessary. Muscle and bone may be permanently damaged. Scarring will cover the healed site. Common cause: High voltage electric or severe fire
• Be certain to ask what caused the burn because different materials cause different degrees of burn
• Ask where the fire happened because fires in closed spaces are apt to cause more respiratory involvement than those in open areas
• Emergency Mgt of Minor Burns

  • Immediately apply cool water to cool the skin - prevent further burning
  • Application of Analgesic-antibiotic ointment and a gauze bandage to prevent infection
  • Keep dressing dry and changed every 2 days
• Emergency Mgt of Moderate Burns

  • Don't rupture blisters
  • Apply topical antibiotic (Silver sulfadiazine-Silvadene) and dressing to prevent damage and infection
  • Broken blisters may be debrided
• Debridement


  The removal of dead (necrotic) or infected skin tissue to help a wound heal. Also done to remove foreign material from tissue.
• Emergency Mgt of Severe Burns


  • Fluid therapy- LR or PNSS
  • Systemic antibiotic therapy
  • Pain mgt - Morphine sulfate IV
  • Physical therapy- prevent contractures
• Emergency Mgt of Electrical Burns


  • Clean with antiseptic solution (Half strength Hydrogen peroxide) 1:1
  • Monitor for airway obstruction
  • Provide bland liquid diet
• Fluid shifts after burn injury


  Increased capillary permeability -> Hypoproteinemia -> Hyponatremia -> Hyperkalemia -> Hypovolemia
• Therapeutic Management of Burns

  • Topical therapy - Silver sulfadiazene, Furacin (If with Pseudomonas)
  • Escharotomy - Cut into the eschar
  • Debridement - Removal of necrotic tissue
  • Grafting- Reduce fluid and electrolyte loss, pain, and infection
• Types of Grafting


  • Allografting - the placement of sterilized and frozen skin (from donor or cadaver) on the cleaned burn site
  • Xenograft - Skin from other sources like pigs, done in small children
  • Autografting - Layer of OWN unburned skin placed over the burned site
• According to the American Association of Poison Control Centers (AAPCC), there are more than 1 million reported poison exposures among children younger than 6 years of age yearly

  
• 90% of the time poisoning occurs in the child's home
• 9,500 children will be hospitalized yearly for unsupervised ingestion of prescription medications
• Poison


  Any substance that is harmful to your body: swallow it, inhale it, inject it, or absorb it through your skin
• Poisoning tends to occur when parents are preoccupied or highly stressed
• Usual agents ingested


  • Soap
  • Cosmetics
  • Detergents or cleaners
  • Plants
  • OTC drugs
  • Vitamins
  • Aspirin
  • Acetaminophen
  • Prescription drugs
• Emergency Mgt of Poisoning at Home


  • Call National Poison Control Center
  • What was swallowed
  • Child's weight and age and how long ago the poisoning occurred
  • Route of poisoning
  • Estimation of how much of poison was taken
  • Child's present condition - (sleepy, hyperactive, comatose)
  • Administer Activated charcoal

  
• Activated charcoal


  Administered to conscious victims only, given ASAP, mixed with water, adding a sweet syrup is suggested, stools will appear black
• Acetaminophen Poisoning


  Causes extreme permanent liver destruction, after ingestion child develops anorexia, nausea and vomiting, increased SGPT and SGOT, antidote is Acetylcysteine or Activated charcoal
• Caustic Poisoning


  Ingestion of strong alkali, such as lye, which is contained in certain toilet bowl cleaners and hair products, causes burns and tissue necrosis in the mouth, esophagus, and stomach, don't let the child vomit

  
• Assessment of Caustic Poisoning

  • Pain in mouth and throat
  • Drools saliva bec. of oral edema and inability to swallow
  • Mouth turns white
  • Vomits blood, mucus and necrotic tissue
  • Tachycardia, tachypnea, pallor, hypotension
• Therapeutic Management of Caustic Poisoning

  • Bring child to nearest Hospital
  • Don't administer Activated charcoal
  • IV Morphine for pain
  • X-ray
  • Laryngoscopy and Esophagoscopy
  • Intubation or tracheotomy

  
• Iron Poisoning


  Large amount of iron is corrosive to the gastric mucosa and leads to severe gastric irritation in the child, immediate effects are nausea, vomiting, diarrhea, abdominal pain, after 6-12 hours can cause melena, hematemesis, cyanosis, vasomotor collapse, coagulation defects, hepatic injury, lethargy and coma
• Therapeutic Management of Iron Poisoning

  • Don't give Activated charcoal
  • Stomach lavage
  • Administer Cathartics
  • Administer Maalox or Mylanta - help decrease gastric irritation and pain
  • Administer IV or IM Deferoxamine
  • GI Xray
  • Liver studies
• Lead Poisoning


  Also called Plumbism, from ingestion of contaminated water, paint chips or paint dust, home-glazed pottery, fumes from burning or swallowing batteries, leads to Hypochromic, microcytic anemia, kidney destruction, and Encephalitis or inflammation of brain cells (toxic level)
• Assessment of Lead Poisoning


  • Lethargy
  • Impulsiveness
  • Learning difficulties
  • Blood level of lead >5µg/dl (unsafe level for children)
• Therapeutic Management of Lead Poisoning

  • Lead levels >10-20 µg/100ml will be prescribed dimercaptosuccinic acid (DMSA) or succimer
  • Lead levels >45µg/100ml will be treated with Dimercaprol (BAL) or edetate calcium disodium (CaEDTA), don't give BAL to patients with peanuts allergy or G6PD deficiency