ENPC

1
ENPC
TIPS

• SPINE
• BRAIN

2
ENPC TIPS
Dope D Dislodgement O Obstruction P
Pneumothorax E Equipment Failure
P PAIN P Pallor P Pulse P Paralysis P
Paresthesia
M Mechanism Of Injury I Injuries Sustained V
Vital Signs T Treatment
Primary Survey A B C D E Secondary Survey F G H I
3
ENPC TIPS
Dope D Dislodgement O Obstruction P
Pneumothorax E Equipment Failure
P PAIN P Pallor P Pulse P Paralysis P
Paresthesia
2 x age 8 wt/kg
EPI 0.01mg/kg 110000
M Mechanism Of Injury I Injuries Sustained V
Vital Signs T Treatment
16 age 4
4
ENPC TIPS
Neurovascular Assessment The
5 Ps P Pallor P Pulse P Pain P
Paresthesia P Paralysis
M Mechanism of Injury I Injuries
Sustained V Vital Signs T Treatment
DOPE D Dislodgement O
Obstruction P Pneumothorax E Equipment
Failure
Neurological Assessment
AVPU A Awake Alert V Verbal Stimuli
only P Painful Stimuli only U Unresponsive
5
C Chief ComplaintI Immunizations
IsolationA AllergiesM MedicationsP
Past Medical History Parents ImpressionE
EventsD Diet DiapersS Symptoms
Pediatric Assessment Triangle
Inspect Auscultate Palpate
Triage History
Appearance
Work of breathing
Circulation
Emergent Urgent Nonurgent
½ first 8 ½ second 16
2-4 cc/kg x BSA over 24 hours
6
(No Transcript)
7
(No Transcript)
8
(No Transcript)
9
(No Transcript)
10
(No Transcript)
11
(No Transcript)
12
(No Transcript)
13
(No Transcript)
14
BURN Fluid Resuscitation Formula
Pediatric patients need Maintenance fluids too

• 2-4 cc/kg x BSA over 24 hours
• ½ in first 8 hours post burn
• ½ in next 16 hours

15
INITIAL ASSESSMENT PRIMARY ASSESSMENT A AIRWAY
B BREATHING C CIRCULATION D DISABILITY E EXPOSE
ENVIRONMENTAL CONTROL SECONDARY
ASSESSMENT F FULL SET OF VITAL SIGNS FAMILY
PRESENCE FIVE INTERVENTIONS G GIVE COMFORT
MEASURES H HEAD TO TOE ASSESSMENT HISTORY
(CIAMPEDS) I INSPECT POSTERIOR SURFACES
16
(No Transcript)
17
(No Transcript)
18
(No Transcript)
19
Traumatic Brain Injury
Primary injuries are those that occur at the
time of impact and are a result of direct
traumatic forces that injure brain tissue and
kill brain cells. Primary injuries occur in a
fraction of a second and may be irreversible.
Common types of primary injuries
include Concussion Contusion and
Laceration Skull fracture Scalp
laceration Epidural hematoma Subdural
hematoma Subarachnoid hemorrhage Diffuse axonal
injury 600,000 yearly treated for head
injuries 25,000 yearly die from head
injuries 30,000 yearly are left with permanent
disabilities Leading cause of acquired
disabilities in childhood Age related
Risks Infants Have large heads in relation
to rest of body. Are commonly result of falls
over 4 months of age Have involuntary reflexes,
such as crawling may propel infants forward
unexpectantly Begin to roll from back to
abdomen in second month which predisposes fall
from heights Motor vehicle crashes are the
major source of severe TBI in infants major
cause is Unrestrained or improperly
restrained child Rear facing child seats from
birth to 20 pounds or one year of age. Toddler
and Preschoolers Are involved in motor vehicle
accidents as passengers and pedestrians. Childre
n who weigh more than 20 pounds and greater than
one year should ride forward Until they are
40 pounds or 4 years of age. The most serious
head injuries often result from
pedestrian-accidents, young thrown onto The
hood, windshield or top of vehicle. School-Age
Children Ages 6 to 12 years Are at risk as
pedestrians and passengers Operated moving
vehicles such as bikes, skateboards,
rollerblades. Injuries are decreased
substantially by the use of helmets. Mechanism of
Injury Relates to the force of impact or
inertial forces that result in injury to the
scalp, skull or brain tissue. The extent of
injury is based on the force and location of
impact, rate of energy transfer and surface area.
20
8 Stages of Development per Erickson
Stage 1 Infancy Birth - 1 year old
Trust vs. Mistrust During this stage an infant
develops a sense of trust. They build on this
level to see how their needs are met. If they
are met consistently they develop trust, if not
consistently met, they develop a sense of
mistrust. Stage 2 The Toddler Period 1 3
years old Autonomy vs. Shame and
Doubt If trust has been developed, then the
infant will be confident enough to accomplish new
skills. They learn from behavior limit setting.
They learn to control their impulses. They try
to be independent. It is important to promote
independence so their autonomy will develop.
Toddlers learn by doing. Stage 3 The Preschool
Period 3 6 years old Initiative vs.
Guilt Preschoolers master developmental tasks
and learn new skills. They develop the ability
to make decisions. They desire to do for
themselves without the help of adults. They
learn thru accomplishments. If they do not make
accomplishments, then they will be reluctant to
act and will develop feelings of guilt Stage
4 The School-Ager 6 12 years old
Industry vs. Inferiority This is the age of
workers and producers. The need achievement.
They learn rules and how to compete and cooperate
with others. They need praise and mastery
development Stage 5 Adolescence 12 18 years
old Identity vs. Role
Confusion The search for personal identity is
in place. A sense of role confusion and identity
crisis emerge during this time. Stage 6 Young
Adulthood 18 40 years old Intimacy vs.
Isolation Young adults prepare to share
meaningful relationships and friendships. During
young adulthood interpersonal development occur
and self identity flourish. Stage 7 Middle
Adulthood 40 65 years old Old
Generativity vs. Stagnation Productivity vs.
Stagnation are the important components of this
development tasks. Stage 8 Older Adult 65
years Ego Integrity vs. Despair A
sense of purpose is vtally important during these
years.
21
AIRWAY VOCALIZATION TONGUE
OBSTRUCTION LOOSE TEETH OR FOREIGN
OBJECTS VOMITUS, BLEEDING, SECRETIONS EDEMA,
DROOLING, DYSPHAGIA PREFERRED POSTURE ABNORMAL
AIRWAY SOUNDS INTERVENTIONS INITIATE
MANUAL CERVICAL SPINE IMMOBILIZATION OR
MAINTAIN SPINE IMMOBILIZATION FOR THE TRAUMA
PATIENT ALLOW PATIENT TO MAINTAIN POSITION OF
COMFORT OPEN AND CLEAR THE AIRWAY JAW
THRUST HEAD TILT CHIN LIFT
POSSIBLE PADDING UNDER SHOULDER SUCTION
IMMEDIATELY FOR VOMITUS OR OTHERSECRETIONS
AIRWAY ADJUNCTS PREPARE FOR ENDOTRACHEAL
INTUBATION
22
BREATHING LEVEL OF
CONSCIOUSNESS SPONTANEOUS BREATHING RATE AND
DEPTH OF RESPIRATION CHEST RISE AND
FALL PRESENCE OF BILATERAL BREATH SOUNDS WORK
OF BREATHING NASAL FLARING, RETRACTIONS, HEAD
BOBBING, ASSESSORY MUSCLE USE JUGULAR VEIN
DISTENTION TRACHAEL POSITION PARADOXICAL
RESPIRATIONS SOFT TISSUE, BONY CHEST WALL
INTEGRITY INTERVENTIONS POSITION
PATIENT DELIVER SUPPLEMENTAL OXYGEN ASSIST
VENTILATIONS ASSESS EFFECTIVENESS OF
VENTILATION LIST INDICATIONS FOR INTUBATION
23
CIRCULATION CENTRAL AND PERIPHERAL PULSE
RATE AND QUALITY SKIN COLOR AND
TEMPERATURE CAPILLARY REFIL UNCONTROLLED
EXTERNAL HEMORRHAGE INTERVENTIONS CONTROL
UNCONTROLLED EXTERNAL BLEEDING OBTAIN VASCULAR
ACCESS INITIATE INTRAOSSEOUS IF NECESSARY FLUID
BOLUS OF 20CC/KG AND REPEAT IF NECESSARY CARDIAC
COMPRESSIONS DRUG THERAPY DEFIBRILLATION OR
SYNCHRONIZED CARDIOVERSION