Pediatric Illness & Injury Urgent vs Emergent

Transcription

1 Pediatric Illness & Injury Urgent vs Emergent Ashley Meyer, MSN, RN, FNP-BC Stevie Wilson, MSN, RN, CPNP

2 Disclosure We have no disclosures. 2

3 Objectives Discuss the indications for recommending Urgent vs Emergent Care Categorize injury into Urgent or Emergent conditions Categorize illness into Urgent or Emergent conditions Identify local resources for care 3

4 Urgent Conditions Urgent conditions do not involve compromise or failure of systems. Symptoms in the system (i.e. wheezing, dehydration, headache, etc.) may be present but the patient's body system is able to compensate. Urgent conditions may evolve into emergent conditions if left untreated. 4

5 Emergent Conditions Compromise or failure of the Respiratory, Cardiovascular or Neurologic Systems 5

6 Respiratory Compromise Increased work of breathing Altered rate of breathing Diminished breath sounds Inability to speak in full sentences Grunting or Stridor Circum-oral cyanosis Altered LOC 6

7 Circulatory Compromise Infrequent except in case of congenital heart disease Altered Heart Rate Hypotension Altered LOC Syncope 7

8 Neurological Compromise Altered LOC Seizure Weakness/numbness in arms or legs Slurred speech Change in behavior Headache 8

9 Injuries 9

10 Headache Nausea/Vomiting Dizziness Sleepiness Head injuries- Common Symptoms Scalp Hematoma (goose-egg) 10

11 Head injuries- Abnormal Findings Child acts confused or unusual Seizures/convulsions Weakness in extremities Eye or pupil abnormalities Emesis > 3 times in 12 hours Difficulty walking or talking Worsening headache 11

12 Emergent-Call 911 Head injuries- Treatment Any loss of consciousness Fall from height or high-impact injury Protect airway Protect C-spine Control bleeding 12

13 Head injuries- Treatment Initial Cold pack Treat lacerations or abrasions Tylenol for pain (avoid ibuprofen) Sips of fluids Rest 13

14 Head injuries- Treatment Initial Monitor for abnormal or worsening findings If worsening symptoms occur Urgent referral to a facility with CT capabilities, most likely an ER, is indicated 14

15 Head injuries- Concussion A concussion is a brain injury causing a temporary disturbance of brain function. Caused by a bump, blow, or jolt to the head or body If a concussion is suspected, seek care Concussion is common with head injury 15

16 Head injuries- Concussion Headache Vomiting Dizziness Blurred vision Balance problems Sensitivity to light and noise Confusion Drowsiness Difficulty concentrating or remembering Fatigue Irritability Emotional issues: nervous, anxious 16

17 Head injuries- Concussion Symptoms of a concussion can last up to 3 weeks! Treatment may include restricted school work, shortened school days and decreased physical activity Initial evaluation and follow up care needed 17

18 Head injuries- Concussion Seek immediate care in this period for: Worsening headache Increased drowsiness Difficulty recognizing people or places Repeated vomiting Unusual/irritable behavior Seizures Weakness/numbness in arms/legs Slurred speech 18

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20 Common Injuries 20

21 Bone and Joint Injuries Soft tissue injury, such as a sprain or strain of a joint space or muscle Torn ligament or tendon Fracture or broken bone 21

22 Assessment Deformity Swelling Sensation Perfusion (pulses, cap refill) Range of motion 22

23 Soft Tissue Injury Usually without point tenderness + Swelling, tenderness with ROM, normal sensation Neurovascularly intact, no deformity Treat with (RICE) rest, ice, compression (splint or wrap), elevation and antiinflammatory medication (Ibuprofen) 23

24 Ligament or Tendon Injury Can be mild or severe Mild may only require RICE (rest, ice, compression (splint or wrap), elevation) and anti-inflammatories Severe may require surgery will have loss of ROM if ligament or tendon is severed 24

25 Fractures - Most common 25 Finger Distal radius (Buckle Fracture) Nursemaid's elbow common in < 5 year old Supracondylar (humerus) Clavicle Lateral malleolus (ankle)

26 Open fracture Emergent Think Basketball..Kevin Ware Surgical emergency Cover with sterile gauze and send to ED Deformity, compromized pulses or cap refill also indicate need for emergent evaluation 26

27 Urgent Injuries with point tenderness may indicate a fracture and should have an x-ray + Fracture may require splinting or casting or a comboniation of both Return to regular activity is determined by the provider 27

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29 Eye injuries Corneal abrasion Symptoms: Tearing Pain Feeling as if something is in the eye Sensitivity to light 29

30 Corneal Abrasion Needs evaluation, including exam of the eye with fluorescent stain. Good candidate for Urgent Care or Primary Care visit. Treatment depends on location of the abrasion on the cornea, may need to see opthomalogist for follow up 30

31 Ruptured Globe of the Eye Caused by blunt or penetrating trauma to the eye Mediacal Emergency to the ER Do not attempt to remove any foreign body from the eye (i.e. tree branch, BB, etc.) Do not apply any pressure to the eye 31

32 Nose Injury/ Nose Bleeds Nose injury: check for septal deviation; treatment may be deferred until edema subsides Nosebleeds: Pressure to nose x 10 minutes, reassess Apply pressure for 10 more minutes as necessary Further evaluation if bleeding does not subside after 20 minutes of direct pressure 32

33 Lacerations/Abrasions Hold pressure to stop bleeding Assess severity Clean with soap and water Apply non-stick dressing Evaluate at an urgent care for sutures if wound is gaping open or bleeding does not stop 33

34 Lacerations Lacerations to lips, tongue, inside of mouth, generally do not require sutures If laceration crosses the Vermilion Boarder of the lip, sutures are necessary 34

35 Lacerations/Abrasions Home Care Keep area clean and dry Monitor for signs of infection Scar care as needed (massage, sunscreen) 35

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37 Common Acute Illness Urgent or Primary Provider Bound 37

38 Common Respiratory Conditions Asthma Croup Allergy URI 38

39 ENT Conditions Ear FB Ear drainage Nosebleeds Sore throat 39

40 Eye Conditions Conjunctivitis Stye 40

41 Conjunctivitis New Recommendations Recommendation for a delayed treatment option Pink Eye often self-limiting condition If symptoms remain for 3 days, then evaluate and treat. 41

42 Conjunctivitis Clinical Practice Guideline Childrensmercy.org Search under for health care professionals Medical resources Clinical practice guidelines (CPG) Conjunctivitis CPG 42

43 Skin Conditions Poison ivy Eczema Scabies Viral Exanthem 43

44 Neurological Condition Headache Seizure 44

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46 Urgent vs Emergent Care Urgent Conditions requiring prescriptions Injuries self-limited care Simple fractures Simple lacerations Common acute illness Emergent Resuscitation Cardiopulmonary failure Anaphylaxis Acute change in LOC or behavior Conditions requiring sedation Cervical spine injuries 46

47 Our Locations 47

48 Bibliography Childrens Mercy Hospital and Clinics (2013), Clinical Practice Guidelines, Conjunctivitis, Retrieved from tice_guidelines/conjunctivitis/conjunctivitis/ Childrens Mercy Hospital and Clinics (2012), Care Card, Nosebleeds, Retrieved from D Alessandro, D. (2012). How is eye globe rupture treated?, Retreived from Fuchs, S. (2009). Seizures. In G.R. Strange, W.R. Ahrens, R.W. Schafermeyer, & R.A. Wiebe (Eds.) Pediatric Emergency Medicine (39-51). Heller, J.L. & Zieve, D. (reviewers). (2011, February 7). Eye Emergencies. Retrieved from http: Su, E. (2009). Mild Head Injury. In G.R. Strange, W.R. Ahrens, R.W. Schafermeyer, & R.A. Wiebe (Eds.) Pediatric Emergency Medicine ( ). 48