Accidents and poisoning.

Joseph muendoFacilitator- Dr Njai

• 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 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 in orifices

• 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 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 of initial damage

• Secondary Response: occurs from cell death caused by a blockage of O2 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

Phase II: Proliferation/Fibroblastic/ Repair/Regeneration Phase

Phase III: Remodeling/ Maturation Phase

Management of childhood injuries.

Based on how the child presents. Airway-look for any signs of obstructionBreathing-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 parameter-

indication of severity.)

• 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 cause of accident.

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 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 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 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 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 Act.pdf

• 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 off with the movement of the baby

• The use of baby-walkers and table-mounted high chairs is not recommended.

Poisoning

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 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 abuse• Benzodiazepines• Iron supplements• Alcohol• Organophosphorus

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 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 abuse?

General measures:• Quick assessment & triage• A…..B…..C…..• Identify the culprit.• Limit absorption: –Vomiting– Lavage (hydrocarbons/acids/alkalis-

contraindicated)–Activated charcoal instillation

Specific:

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 saline2.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 1st hour !!!!

– Naso/oro-gastric Lavage– Bowel Irrigation:–Recent ingestions –Awake alert patient–500 cc NS Children / 2000cc adults–Orally / Nasogastric tube–Contraindications…?

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 lavage !!!!!!–Risk of aspiration outweighs any benefit

from removal of substance–CXR around 2-4 hrs “not before 2hrs”–Observe in ER for 6-8 hrs if no symptoms

discharge.

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….B….C….. StabilizationWash hair and body with soap & waterConsider Gastric lavage if within 1hr

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 muscle

paralysis must support breathing

USECholinestrase reactivator such as Pralidoxime

Dose = 1gm /kg IV Q 30 mins

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 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 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%.

Poisoning prevention

• poisoning prevention.docx