Pre-hospital intubation for pediatric trauma victims is not necessary
Table of Contents
INTRODUCTION 3
AIRWAY MANAGEMENT IN EMERGENGIES 3
PAEDIATRICS AIRWAY ANATOMY 4
IS PRE-HOSPITAL INTUBATION FOR PAEDIATRICS TRAUMA VICTIMS NECCESSARY? 6
CONCLUSION 8
REFERENCES 9
INTRODUCTION
The data from World Health Organization (WHO) on the leading causes of death worldwide and the global burden of diseases shows that, traumatic injuries are the major cause of mortality, morbidity and disability among children (0 – 14 years) - being responsible for more deaths than the combination of other diseases1. It is against this backdrop that pre-hospital care during emergencies becomes very important in the management of the injured children as it is for adults. In most circumstances, earliest responder who could be a medical doctor, paramedic, or even layman are the first to provide the much needed life saving (basic or advance), vital medical care all with the aim of optimizing the victim’s physiological status prior to arriving nearest medical facility2, 3. Indeed, several evidences suggested that these first life-saving supports have effect on the morbidity and mortality of the injured patient2-4. But, recent researches have also shown that interventions like invasive airway management, IV access and fluid administration are associated with higher rate of complication and failure among paediatric patients, while the few that turned out to be successful were provided by specially trained and experienced personnel3. This is due to the difference in size and overall anatomy of children compared with adult, thus many of these procedures turn out to be difficult or results in complication when performed...
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...severe head injury. Journal of Trauma [serial online]. December 2000; 49(6):1065-1070. Available from: CINAHL Plus, Ipswich, MA. Accessed March 7, 2014.
Gerritse B. M., Advanced medical life support procedures in vitally compromised children by a helicopter emergency medical service. Emerg Med. 2010; 10: 6. Published online 2010 March 8. doi: 10.1186/1471-227X-10-6
Wang H, Yealy D. Out-of-hospital endotracheal intubation: where are we? Annals of Emergency Medicine [serial online]. June 2006; 47(6):532-541. Available from: CINAHL Plus, Ipswich, MA. Accessed March 7, 2014.
DiRusso S, Sullivan T, Risucci D, Nealon P, Slim M. Intubation of pediatric trauma patients in the field: predictor of negative outcome despite risk stratification. Journal of Trauma [serial online]. July 2005; 59(1):84-91. Available from: CINAHL Plus, Ipswich, MA. Accessed March 7, 2014.
This is achieved through the close relationship of the family members the pediatric patient. Safety is increased because the family members are treated as part of the health care team and not simply visitors (Moore, Coker, DuBuisson, Swett, & Edwards, 2003). Furthermore, the patients are able to communicate with personnel about what they see happening to their child as well as making decisions regarding what treatments they want their infant to receive (Moore et al., 2003). The input from the patient 's family is very important in ensuring patient safety because the family members know the patient much better than medical staff (IWK Health Centre, 2016). This allows family members to more acutely notice changes in the pediatric patients status which allows them to quickly notify health care professionals. This could prove very beneficial when providing care for a pediatric patient in intensive
This essay describes how the anaesthetic machine and airway management equipment are prepared in operating theatres and discusses how they are ensured safe for use. It evaluates the Association of Anaesthetists of Great Britain and Ireland (AAGBI) guidelines related to safe practice and the preparation of the ET tubes, laryngeal masks, guedels, Naso pharyngeal airways and the laryngoscope. The function of the anaesthetic workstation is to deliver a mixture of anaesthetic agents and gases safely to the patient during the induction process and throughout surgery. In addition, it also provides ventilation to support breathing and monitors the patient’s vital signs to minimise the anaesthetic risks to the patient whilst in the care of health professionals. The pre-use check is vital to patient safety as an inadequate check of the anaesthetic machine or airway management equipment can and does lead to significant harm of the patient including mortality (Medicines and Healthcare Products Regulatory Agency (MHRA), 2008 and Magee, 2012).
A. Background In recent years, there has been an increase in research investigating the long-term effects of repeated head trauma on the brain, especially in athletes. Following his discovery of chronic traumatic encephalopathy (CTE), Dr. Bennet Omalu inspired a movement of research aimed at establishing better safety standards and protocols in football. It was not until 2002 that the initial connection between repetitive head trauma, such as concussions, and brain injury was suspected (Ott, 2015). As common as concussions were during the late 1970s and 1980s, they were often swept under the rug, as they were seen as insignificant injuries.
Did you know, that someone suffers from a brain injury every 21 seconds (Haas)? Children get concussions all the time, and most of the time they go unnoticed. The majority of concussions happen when one is playing a sport such as football, hockey, or lacrosse. Many famous athletes have had their careers, even their lives cut short due to concussions. Brain damage and death can result from serial concussions (Schafer). When one suffers from a concussion, one’s brain needs time to recover physically and mentally. Between 2002 and 2006, statistics showed that 52,000 people died from concussions and about 275,000 were hospitalized (Fundukian). Everyone’s recovery process is different (“Injury and Pain Care”). Although concussions seem minor, they are very serious brain injuries that may result in severe damage to one’s brain.
Thesis: Concussions affect children and adults of all ages causing physical, emotional and metal trauma to a person and their brain.
Adirim, Terry A. “Concussions in Sports and Recreation.” Clinical Pediatric Emergency Medicine 8.1 (2007): 2-6. Print.
The only result from the testing consistent with a brain injury was the abnormal pupil response of the right eye (constriction) (Traumatic brain injury, 2015). The physical effects that could have pointed to a brain injury were the laceration to the right side of the gentleman’s head and the amount of blood loss. The complaints from the patient that may have insisted a brain injury included a severe headache, dizziness, and nausea (Traumatic brain injury, 2015).
Are intubated patients placed at a greater chance of infection based on the initiation of parenteral verses enteral nutritional support?
To perform CPR, first you must establish unresponsiveness. Try tapping the child and speaking loudly, to provoke a response. Once unresponsiveness has been determined, if you are alone, you should shout for help. Then provide basic life support for approximately one minute before going to call 911. If a second person arrives, send him or her to call the ambulance.
(10) Levi B.H., Thomas N.J., Green M.J., Rentmeester C.A. & Ceneviva G.D. (2004), jading in the paediatric intensive care unit: implications for healthcare providers of medically complex children. Paediatric Critical Care Medicine 5 (3), 275–277. (11) Ward. E [1990] Ch. 359.
American Association of Nurse Anesthetists. Professional Aspects of Nurse Anesthesia Practice. Philadelphia: F. A. Davis Company, 1994. Print.
British Thoracic Society, (2008), Guideline for Emergency Oxygen Use in Adult Patients, Thorax: an International Journal of the Respiratory Medicine, 63 (6), DOI: 10.1136/thx.2008.102947
Difficulty in airway management is considered a major cause of morbidity and mortality in anaesthesia. Hence it is important to identify patients at risk for tracheal intubation in an otherwise apparently normal airway. Difficult airway is defined as clinical situation in which a trained anaesthesiologist has difficulty with mask ventilation, tracheal intubation, or both.
Stocchetti, N., Pagan, F., Calappi, E., Canavesi, K., Beretta, L., Citerio, G., … Colombo, A., (2004). Inaccurate early assessment of neurological severity in head injury. Journal of Neurotrauma, 21(9), 1131-1140. doi:10.1089/neu.2004.21.1131
First aid trained personnel and the first aid kit are the best tool to prevent further damage to the injured and make sure they are on the recovery path swiftly without any problems.