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Accidents and poisoning. Joseph muendo Facilitator- Dr Njai Accidents and poisoning. Joseph muendo Facilitator- Dr Njai

 • Accident is an unexpected and undesirable event, especially one resulting in damage • Accident is an unexpected and undesirable event, especially one resulting in damage or harm.

 • Home accidents account for 38% of all accidental deaths in children under • Home accidents account for 38% of all accidental deaths in children under five, 58% of accidental deaths occur in or about the home. If non-fatal accidents are added, the rate of all accidents occurring in the home varies from 51. 6% at 10 to 14 years of age to 91. 3% for children under 1 year of age.

classification Mainly classified according to cause: -road traffic accidents -Drowning -burns -poisoning -foreign bodies classification Mainly classified according to cause: -road traffic accidents -Drowning -burns -poisoning -foreign bodies in orifices

 • • • Glass related accidents and cuts Animal/snake bites Electricity associated injuries. • • • Glass related accidents and cuts Animal/snake bites Electricity associated injuries. Explosion Suffocation and choking

Risk factors for childhood accidents - Age- from 3/12 to 4 years prone to Risk factors for childhood accidents - Age- from 3/12 to 4 years prone to accidents at home. More than 4 years –road accidents/playing outside. - Sex- male more than female children - Inadequate/absent adult supervision - Environment child is exposed to. Rural vs urban

pathogenesis • Primary Response: tissue destruction directly associated with traumatic force; can’t change amount pathogenesis • Primary Response: tissue destruction directly associated with traumatic force; can’t change amount of initial damage • Secondary Response: occurs from cell death caused by a blockage of O 2 supply; can assist to keep minimum damage to other tissues Injury Response Cycle = pain-spasm-pain cycle (Chemicals stimulate free n. endings & cause pain which causes m. spasm & triggers body’s protective mechanism. )

Three phases of healing Phase I: Acute Inflammatory Phase II: Proliferation/Fibroblastic/ Repair/Regeneration Phase III: Three phases of healing Phase I: Acute Inflammatory Phase II: Proliferation/Fibroblastic/ Repair/Regeneration Phase III: Remodeling/ Maturation Phase

Management of childhood injuries. Based on how the child presents. Airway-look for any signs Management of childhood injuries. Based on how the child presents. Airway-look for any signs of obstruction Breathing-ensure good bilateral air entry. Also observe rate and rhythm of breathing. Circulation-observe pulse-rate rhythm and volume. Blood pressure important. (Consciousness also an important parameterindication of severity. )

 • Important to look for injury-from bleeding to fracture sites. • Contaminated clothing • Important to look for injury-from bleeding to fracture sites. • Contaminated clothing must immediately be removed to reduce further poisoning • After stabilization-take a good history-from person on site or person who found the child. • Avoid panic especially from parent/caregiver to establish cause.

 • Subsequent management after stabilization and taking good history will be based on • Subsequent management after stabilization and taking good history will be based on cause of accident.

Prevention • Most accidents can be prevented with increased vigilance amongst parents and caregivers. Prevention • Most accidents can be prevented with increased vigilance amongst parents and caregivers.

 • Environment This involves safety of the area children are exposed to. In • Environment This involves safety of the area children are exposed to. In the house includes kitchen/store/medicine cabinets-access should be limited. children like to imitate adults(learning mechanism).

 • Education This involves increasing the awareness of the risk of accidents in • Education This involves increasing the awareness of the risk of accidents in a variety of settings and providing information on ways of reducing these risks. this information is not only for parents but also for caregivers(egs)

 • Empowerment Local consultation and community involvement can generate a strong sense of • Empowerment Local consultation and community involvement can generate a strong sense of commitment and ownership. Accident prevention initiatives, which have been planned by the community, are more likely to reflect local need and therefore encourage greater commitment. (crossing roads/gated communities/provision of playgrounds)

 • Law Enforcement There is legislation which relates to child safety. These regulations • Law Enforcement There is legislation which relates to child safety. These regulations ensure that the products we buy meet a reasonable level of safety performance and that new dwellings meet an acceptable level of safety. • Child protection act-12. The Children's Act. pdf

 • General safety advice • Children should be supervised at all times • • General safety advice • Children should be supervised at all times • Keep floors free of toys and obstructions that can be tripped over • Always use a securely fitted safety harness in a pram, pushchair or highchair • Never leave babies unattended on raised surfaces

 • Do not place baby bouncers on raised surfaces - they could fall • Do not place baby bouncers on raised surfaces - they could fall off with the movement of the baby • The use of baby-walkers and table-mounted high chairs is not recommended.

Poisoning occurs when any substance interferes with normal body functions after it is swallowed, Poisoning occurs when any substance interferes with normal body functions after it is swallowed, inhaled, injected, or absorbed. The branch of medicine that deals with the detection and treatment of poisons is known as toxicology.

 • “All substances are poisons. . . the right dose separates poison from • “All substances are poisons. . . the right dose separates poison from a remedy. ” • Ingestion of a harmful substance is among the most common causes of injury to children less than six years of age.

Compounds involved • • Amino salicylic acid Acetaminophen Tricyclic antidepressants Narcotics & drugs of Compounds involved • • Amino salicylic acid Acetaminophen Tricyclic antidepressants Narcotics & drugs of abuse Benzodiazepines Iron supplements Alcohol Organophosphorus

Important issues in history • What toxic agent/medications were found near the patient? • Important issues in history • What toxic agent/medications were found near the patient? • What medications are in the home? • What approximate amount of the “toxic” agent was ingested? – How much was available before the ingestion? – How much remained after the ingestion? • When did the ingestion occur ?

 • a history of substance abuse ? • Were there any characteristic odors • a history of substance abuse ? • Were there any characteristic odors at the scene of the ingestion? • Was the patient alert on discovery? – Has the patient remained alert since the ingestion? – How has the patient behaved since the ingestion? • Does the patient have a history of substance

General measures: • Quick assessment & triage • A…. . B…. . C…. . General measures: • Quick assessment & triage • A…. . B…. . C…. . • Identify the culprit. • Limit absorption: – Vomiting – Lavage (hydrocarbons/acids/alkaliscontraindicated) – Activated charcoal instillation Specific:

ABC’s of Toxicology: • Airway • Breathing • Circulation • Drugs: • Resuscitation medications ABC’s of Toxicology: • Airway • Breathing • Circulation • Drugs: • Resuscitation medications if needed • Universal antidotes • Draw blood: • chemistry, coagulation, blood gases, drug levels • Decontaminate • Expose / Examine • Full vitals / Foley / Monitoring • Give specific antidotes / treatment

 • Decontamination: 1. Ocular: – Flush eyes with saline 2. Dermal: – Remove • Decontamination: 1. Ocular: – Flush eyes with saline 2. Dermal: – Remove contaminated clothing – Brush off – Irrigate skin 3. Gastro-intestinal: – Activated charcoal: – May Prevent /delay absorption of some drugs/toxin.

– Almost always indicated Only in the 1 st hour !!!! – Naso/oro-gastric Lavage – Almost always indicated Only in the 1 st hour !!!! – Naso/oro-gastric Lavage – Bowel Irrigation: – Recent ingestions – Awake alert patient – 500 cc NS Children / 2000 cc adults – Orally / Nasogastric tube – Contraindications…?

Hydrocarbons-kerosene -Risk of aspiration – GIT & Respiratory effects. – Burning sensation, nausea, belching Hydrocarbons-kerosene -Risk of aspiration – GIT & Respiratory effects. – Burning sensation, nausea, belching and diarrhea – Cough, chocking, gagging and grunting. – CXR 2 -8 hrs later: Pulmonary infiltrates or peri-hilar densities. – Pneumatoceles, pleural effusion or pneumothorax and bacterial super-infection – Resolution 2 -7 days.

 • Treatment: – Do not induce vomiting !!!!! – Do not attempt gastric • Treatment: – Do not induce vomiting !!!!! – Do not attempt gastric lavage !!!!!! – Risk of aspiration outweighs any benefit from removal of substance – CXR around 2 -4 hrs “not before 2 hrs” – Observe in ER for 6 -8 hrs if no symptoms discharge.

Organophosphorus compounds • Organophosphorus compounds: – Insecticides – Inhibition of Cholinesterase enzymes all over. Organophosphorus compounds • Organophosphorus compounds: – Insecticides – Inhibition of Cholinesterase enzymes all over. • Muscarinic N/V Abdominal pain/ fecal incontinence • Cholinergic : cough, resp. secretions, crepitation and even pulmonary edema • CVS : Tachycardia/ bradycardia/ block/ hypotension • Nicotinic: restlessness, confusion, coma, flaccidity/convulsion

Diagnosis: blood Cholinesterase levels < 50% indicates poisoning. Atropine as test dose Management: A…. Diagnosis: blood Cholinesterase levels < 50% indicates poisoning. Atropine as test dose Management: A…. B…. C…. . Stabilization Wash hair and body with soap & water Consider Gastric lavage if within 1 hr Atropine sulphate I. V. till pupils are normal size. Dose = 0. 02 mg/kg Q 15 -20 mins

Atropine sulphate I. V. till pupils are normal size. Remember…Atropine has no effect on Atropine sulphate I. V. till pupils are normal size. Remember…Atropine has no effect on muscle paralysis must support breathing USE Cholinestrase reactivator such as Pralidoxime Dose = 1 gm /kg IV Q 30 mins

Carbon monoxide poisoning • CO is a colorless and odorless gas that is created Carbon monoxide poisoning • CO is a colorless and odorless gas that is created when burning a fuel, such as gasoline, propane, natural gas, oil, wood and charcoal. • improperly ventilated stoves and fireplaces, as well as running cars, can lead to a build up of CO gas in enclosed or semi-enclosed spaces.

 • Because of their high metabolic rates and high tissue oxygen demands, children • Because of their high metabolic rates and high tissue oxygen demands, children are biologically at increased risk of CO poisoning when exposed to CO. • Common symptoms include headache, dizziness, fatigue, nausea, vomiting and confusion. • May lead to coma and death. • CO poisoning can often be mistaken for flu or food poisoning. If CO leak, more than one person may have symptoms.

management • Attention to the ABCDs of resuscitation is the mainstay of emergency care management • Attention to the ABCDs of resuscitation is the mainstay of emergency care for the patient with CO intoxication. • All patients with suspected or confirmed CO exposure should be given 100% oxygen until they are asymptomatic and the carboxyhemoglobin (COHb) concentration is below 10%.

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