| Accidents & Injuries | ||
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Most ankle injuries and knee injuries do not need to be seen in the emergency room. If the child can bear some weight and the lower leg is not deformed, ankle injuries can be managed at home For ANKLE Injuries remember the word RICE. R= rest I= ice C= compression E= elevation DO NOT TRY TO "WALK OFF" OR "RUN THROUGH" ANKLE INJURIES
Emergencies
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Accidents can
happen but many are preventable. Review the child proofing list in the
baby handout (Keeping
your baby safe from harm).
Think also about grandparents and other care givers home. Keep emergency
numbers close at hand and provide these for baby sitters, grandparents,
etc. Falls are very common. Generally, if child falls and afterwards acts ok then he probably is OK, the exception being if the fall was from considerable height. Mild head trauma is very common. Hitting the forehead causes large goose bumps but usually no harm. If a toddler hits his head, either from the injury or from getting upset and crying he make vomit or even become a bit sleepy once he has settled down. If a toddler has one or two bouts of emesis immediately around the time of the accident he can still be observed at home, but if it’s hours later or persists beyond the first few minutes then he probably should be checked. Likewise, if he is drowsy right after hitting his head and crying, you can let him sleep for 20 minutes but if he is persistently drowsy or drowsy hours later during a time when you would expect him to be alert, then he should be checked. Older children need to be able to give quick coherent answers to information that they should know.With respect to extremity injuries one of the first things to look for is whether the limb is deformed. If this is the case then he needs to be seen in the emergency room. If there is no obvious deformity then he can be observed. A child who has significantly injured his leg will at least limp and probably not walk. Most sprains, however, can be treated with ice, elevation and compression overnight and be evaluated the next day. Common arm injuries included broken wrists, fractured clavicles, and nursemaid’s elbow. A child who has broke his wrist generally will use the other hand and show pain when you press on the wrist area. It may appear puffy. A child with a broken collar bone will cry when you pick him up by the arms or show pain and swelling over the collarbone area. Nursemaid’s elbow most often results from a pulling injury on the arm which pops a tendon out of place. The arms hangs limply at the side or the child holds the arm at the wrist and will not move it. If your are sure this is the problem, then holding the affect arm straight out with the palm up and thumb out then turning the arm all the way around so that the thumb points out again will fix most nursemaid’s elbows. Cuts and bruises are pretty common. To stop bleeding apply direct pressure. A cut in which you can see fat tissue underneath or gapes open 1/8th of an inch may need stitches. Burns should be immediately immersed in cold water or have ice applied to limit the extent of the burn. Burns with blisters or slough skin are at least second degree. If it is a small burn it can be gently washed with cool water leaving blisters intact, have polysporin applied (silvadene is really not necessarily), wrapped with sterile gauze and evaluated in the morning. Burns that are circumferential (go all the way around an extremity). take up large amounts of an extremity or the trunk, or that involve most of the palm should be examined on an emergent basis either in the office or emergency room. Sometimes burns need tetanus shot prophylaxis. All burns should be observe for signs of infection which are increasing redness and tenderness around the burn site, fever, and possibly purulent discharge. Tetanus shots are good for five years if the wound is dirty and 10 years if clean.
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