emergency care of the child

shock

inadequate tissue perfusion

leads to hypotension, hypoxia, and metabolic acidosis

caused by hypovolemia, vascular resistance, or pump failure

shock s/x

mottled, pale, or gray skin

cold starting in extremities that moves inward

slow cap refill

lethargy+decreased pain response

irritable

poor feeding (infants)

anaphylaxis

type of shock

hypersensitivity to an allergen

causes release of histamine→vasodilation and bronchoconstriction

prevention is key

anaphylaxis s/x

edema

dizziness

headache

hypotension

impaired CO

anaphylaxis t/x

epinephrine

ensure airway

vasopressin

fluids

septic shock

infection triggers an inflammatory response

causes vasodilation and increased capillary permeability

septic shock t/x

provide hemodynamic stability

target infectious agent/antibiotics

ensure adequate oxygenation to tissues

vasopressin

vasoconstrictors

steroids for hyperglycemia and electrolyte imbalance

SIRS

systemic inflammatory response syndrome

caused by infection or noninfection (trauma, burn)

box 42.14

toxic shock syndrome

caused by exposure to toxins from staphyloccocus

can cause organ failure

prevention is key (tampon education)

t/x the same as shock

hypovolemic shock t/x

stabilize ABCs

fluids at 20 units per kilo

distributive shock t/x

blood products

cardiogenic shock t/x

monitor central venous pressure

arterial BP+arterial pulmonary pressures

fluids can cause fluid overload

blunt force trauma

usually from fall or being struck by an object

ask if there was LOC (how long and if they have memory)

monitor headache+vomiting

penetrating trauma

stabbing, firearm, blast, or other impaling injury

severity depends on location and type of injury

multiple trauma

when more than one body system is affected due to a trauma

ex. MVA

waddell’s triad

pattern of injuries seen in children struck by a motor vehicle

abdominal/thoracic injury

femur/leg injury

head injury

primary assessment

stabilize cervical spine

breathing assessment and management

circulatory assessment

secondary assessment

maintain cervical spine protection until injury is ruled out

complete head to toe (log roll to look for back injuries)

history of injury

assessing and reporting mistreatment

look for fractures in various stages of healing

when h/x of injury doesn’t align w/ injuries

patterns of injury that suggest specific object caused injury

red flag if they delayed seeking treatment

report even if you just suspect something

poison

call poison control before initiating interventions

assess+monitor mental status

check ABCs

gastric decontamination if appropriate

activated charcoal

lead poisoning

from old homes or furniture w/ lead based paint

may be cultural component w/ cosmetics and remedies

level of exposure is shown through elevated erythrocyte porphyrin

many cognitive s/x (aggressive, impulsive, hyperactivity, disinterest, withdrawal, developmental delays)

long term exposure can lead to encephalopathy

interferes w/ iron metabolism→anemia

affects kidneys, growth, and reproductive efficiency

table 32.3