What is Emergency Medicine - What is a concussion, exactly? How should returning to activities be advised to patients and parents?
According to conventional neuroimaging, a concussion is defined as trauma-induced brain dysfunction without structural damage. Although early loss of consciousness can accompany concussions, it is not necessary for diagnosis. A youngster may have amnesia, disorientation, headaches, dizziness, nausea, or vomiting at first. If CT imaging is performed, it will be normal, but magnetic resonance imaging may reveal minute diffuse axonal abnormalities (MRI). Recent recommendations advise against "brain rest" and instead support an instant but gradual return to some form of physical and mental activity. Athletes should be taken out of competition and strenuous activity as away, but if symptoms are mild, they may be allowed to walk quickly. Each youngster should receive specialized accommodations for their schooling. Screen use should be restricted based on symptoms because complete screen abstinence can increase social isolation and worsen mood issues. Think about decreasing brightness, length, and font size. Headaches, memory loss, sleep disturbances, and behavioral or psychiatric problems are examples of sequelae. The typical duration of concussion symptoms is 5-7 days, but in some kids, particularly younger kids, they might continue for weeks or even months. This risk should be discussed with parents and kids, and a clear follow-up with a primary care provider should be scheduled.
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What is Emergency Medicine - Which kids who have suffered minor head trauma require computed tomography (CT) imaging?
By identifying children at very low risk for clinically significant traumatic brain injury, the Pediatric Emergency Care Applied Research Network (PECARN) decision guidelines are used to direct clinicians' use of imaging (ciTBI). Numerous validation studies have demonstrated the high sensitivity (99%–100%) and moderate specificity (55%–69%) of the guidelines (below) for ciTBI. • Children under 2 years old: normal mental condition, no scalp hematoma (excluding frontal), no loss of consciousness or loss of consciousness lasting less than 5 seconds, no severe mechanism, no perceptible skull fracture, and acting normally in the eyes of the parents. • at least two years old: normal mental condition, no vomiting, no loss of consciousness, no severe mechanism, no evidence of a basilar skull fracture, and no excruciating headache. Consider a term of surveillance for all children with normal mental status and no indication of skull fracture if they do not fit the low-risk criteria specified in PECARN. It should be mentioned that clinical judgment has also proven to be quite sensitive and possibly even more precise in identifying which kids need a CT. What is Emergency Medicine - . List the various traumatic brain injury kinds and factors that increase the likelihood of negative consequences.
Subdural hematoma, epidural hematoma, intraparenchymal hemorrhage, subarachnoid hemorrhage, and cerebral contusion are all examples of focal brain injuries. Minor concussions to diffuse axonal injury, caused by shearing forces at the gray-white matter interface, are examples of mild diffuse brain injuries. Poor outcomes are linked to low initial GCS score, younger age (4 years old), hypotension, coagulopathy, and hyperglycemia. What is Emergency Medicine - What is the main reason for child trauma-related impairment and death?12/29/2022 What is Emergency Medicine - What is the main reason for child trauma-related impairment and death?
brain damage caused by trauma. What is Emergency Medicine - What factors should be taken into account while inserting an intraosseous (IO) line in a child?
IO lines may be added quickly and easily. If a peripheral line cannot be established right away, the insertion of an IO line should be taken into consideration in any critically ill patient. IO lines are secure for administering almost any liquid, blood product, or medication. The rate of infusion is comparable to a 21-gauge IV. White blood cell count, potassium, calcium, and aspartate transaminase/alanine transferase (AST/ALT) tests may not be reliable even if the majority of serum laboratory testing can be sent from an IO aspirate. The proximal tibia beneath the tibial tuberosity is the optimum location. The medial malleolus and the distal femur are additional potential locations. When a youngster has acquired skeletal maturity in late adolescence, the proximal humerus should be avoided. A maximum dose of 40 mg of 0.5 mg/kg of 2% lidocaine (20 mg/mL) may be given to the aware youngster who is suffering pain from an intravenous infusion (2 mL). To avoid damaging the growth plate, IO lines should not be positioned distal to a fracture and should be directed away from the physis. Once peripheral or central IV access has been established, they should be removed within 24 hours. Cellulitis, osteomyelitis, growth plate damage, fat embolism, compartment syndrome, and iatrogenic fractures are among the uncommon complications. What is Emergency Medicine - What is seat belt syndrome, exactly?
The classic trio of abdominal wall ecchymosis, hyperflexion-distraction damage to the lumbar spine (Chance fracture), and IAI is known as seat belt syndrome, sometimes known as lap belt syndrome. When a child is wearing a seat belt incorrectly (high over the abdomen instead of low over the pelvis, or with the shoulder belt behind the child's back), it is typically related to car accidents. Even only a seat belt sign has a strong correlation with IAI. To lower the morbidity and death rates among children involved in auto accidents, proper installation and usage of car seats, including booster seats, is crucial. What is Emergency Medicine - What is a handlebar injury, exactly?
The term "handlebar injury" describes a direct impact from a bicycle handlebar to the abdomen, either with or without obvious external symptoms of trauma. Abdominal wall hernias, solid organ injuries, and hollow viscous injuries are all highly likely following handlebar accidents. What is Emergency Medicine - What is the Waddell triad?
When a kid is hit by a car quickly, Waddell's triad, which includes a femur fracture, intraabdominal or intrathoracic injury, and brain injury, can happen. When large blunt force is given to a little body mass, it is an illustration of a child's potential for multisystem injury. What is Emergency Medicine - What is an infant's typical blood volume?
A 5-year-old weighing 20 kg has a total blood volume of 1.6 L, or approximately 80 mL/kg. What is Emergency Medicine - How can I spot shock in a young patient?
Children have stronger hemodynamic compensation mechanisms and enhanced physiologic reserve. Because of this, even when there is severe blood loss, they frequently keep their blood pressure within the normal range (this is known as compensated shock). Because they are less able to enhance their cardiac contractility, young children must increase their heart rates and vascular resistance in order to maintain their blood pressure and cardiac output in the face of blood loss (SVR). It is crucial to check children for other hemodynamic instability symptoms, such as poor skin perfusion (mottling of the skin, cool extremities, capillary refill lasting longer than 2 seconds), decreased pulse pressure, increased work of breathing, and abnormal mental status, in addition to the vital sign abnormalities listed below (depressed level of consciousness or agitation). • Tachycardia in the injured youngster may be brought on by pain or mental distress, but it should always alert the medical professional to potential blood loss. • Bradycardia, which can signal cardiac arrest, is a concerning symptom in injured children and can be brought on by head damage, spinal cord injury, respiratory failure, or severe shock. • In children, hypotension could be a late or perimortem symptom of shock. Using a child's age as a guide, quickly calculate the fifth percentile for the lower limit of normal blood pressure: • Children aged one:.60 mmHg • For children aged 1 to 10: [70 + (2 x Age in years)] mmHg • Take into account calculating the shock index by dividing the heart rate by the systolic blood pressure. the principles. Concern should be expressed because these values—1.2 for children aged 4-6, 1.0 for children aged 7–12, and 0.9 for those aged 13–19—have been linked to higher rates of surgery, intubation, and blood transfusion when compared to hypotension alone. |
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