Transcript Slide 1

CAMS STAFF:
• Carrie Simonson RN SANE-P
“HASBRO”
• Arne Graff MD
HOME SWEET HOME?
ARNE GRAFF MD
CAMS
SANFORD HEALTH
OBJECTIVES:
• REVIEW OF RISKS WITHIN A HOME FOR
CHILDREN
• REVIEW OF THE MECHANICS OF INJURY
UNINTENTIONAL INJURIES
• LEADING CAUSE OF DEATH IN CHILD > 1
• 1-4 YEAR OLD 34%; 5-9 YEAR OLD 37%
• MAJORITY ARE MVA
• 1000000 ER VISITS/YR FOR HOME ACCIDENTS IN KIDS
• NEGLECT ACCOUNTS FOR 60% CHILD MALTREATMENT
• NEGLECT ACCOUNTS FOR 41% ABUSE DEATHS
UNINTENTIONAL INJURIES
• ACCIDENT LOCATIONS (MOST COMMON):
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KITCHEN
DINING ROOM
BATHROOM
STAIRS
• MOST COMMON INJURIES:
– BURNS/SCALDS
– FALLS FROM HEIGHTS
UNINTENTIONAL INJURIES
• MOST PARENTS DO NOT USE BARRIERS IN HOME
• (EVEN WHEN GIVEN FREE TO FAMILY)
• PARENTS UNDERESTIMATE POTENTIAL RISK
• PARENTS OVERESTIMATE SKILL OF CHILD
• SOCIAL PRESSURE
UNINTENTIONAL INJURIES
• TIMING:
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LATE AFTERNOON OR EVENING
HOLIDAYS
SUMMER
WEEKENDS
• RISK FACTORS:
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CHANGE IN ROUTINE
STRESS (DEATH IN FAMILY)
CHRONIC ILLNESS IN HOME
INADEQUET SUPERVISION
“RUSH” ATMOSPHERE
CROWDED HOMES (MULTIFAMILY)
UNINTENTIONAL INJURIES
• COST PER YEAR: $200 MILLION
• ONE BATH SCALD COST: $250,000
STAIRWAYS
STAIRWAY FALLS:
• “SERIES OF FALLS”
• FIRST FALL IS THE “LONGEST”
• INJURIES MORE PRONOUNCED:
– CARRIED BY ADULT
– IN WALKER
• MOST COMMON INJURIES NOTED:
– HEAD AND NECK
– DISTAL EXTREMITIES
• UNCOMMON INJURIES NOTED:
– TRUNK
– PROXIMAL EXTREMITIES
• NUMBER OF STAIRS:
– DOES NOT AFFECT LIKELIHOOD OF INJURY
– DOES NOT AFFECT SEVERITY OF INJURY
STAIRWAY FALLS
• WITNESSED ?
• GATE IN PLACE ?
• TYPE OF MATERIAL FOR STAIRS AND LANDING
• CARRIED, FELL ON OWN, WALKER, OTHER
• INJURIES = HISTORY
WALKERS
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1993 25,000 ER VISITS
NUMBERS DECREASING (DUE TO DECREASED USE)
34 DEATHS RELATED
75% OF “MORE SERIOUS” INVOLVE STAIRS
INJURIES:
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BURNS (RIM DOESN’T EXTEND BEYOND REACH)
HEAD INJURIES
FRACTURES
DENTAL INJURIES
CONTUSIONS
LACERATIONS
DEATH
FINGER ENTRAPMENT
WALKER HISTORY
• TYPE OF WALKER
• PICTURES OF IT
• NEW, OLD, BROKEN
COUCH
(ALSO KNOWN AS THE KILLER
COUCH)
SHORT FALLS:
• RARE TO SEE SIGNIFICANT INJURIES
• PLUNKETT STUDY: 75000 ACCIDENTS/ 18 DEATHS
• MAY SEE: FRACTURE, SDH, RH, EDH, CONTUSION, SCALP
INJURY (<50% BRUISING)
• IMPORTANT: < 6’ VS >6’
• WORKUP:
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DISTANCE FALLING
FLOOR COVERING
UNSURFACE TYPE
STARTING POSITION
PEAK ACCEL
1’ FALL
ONTO CONCRETE: 42,000
ONTO CARPET : 30,000
ONTO BED
: 1,000
5’ FALL
ONTO CONCRETE: 80,000
ONTO CARPET : 70,000
ONTO BED
: 5,000
SLAM
ONTO CONCRETE: 173,000
ONTO CARPET : 160,000
DELTA-V
70
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85
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275
170
BED INJURIES:
• SIMPLE FALLS
• CO-SLEEPING
– REASONS: BREASTFEEDING, CONVIENCE, PRACTICAL
– INCREASED RISK: OVERLAY, WEDGING, FACIAL OCCLUSION,
SUFFOCATION (FACE DOWN), STRANGULATION, SIDS
– RISK FACTORS: LARGE ADULT, SMALL CHILD/INFANT, SOFT BEDDING,
BLANKETS, SMOKING/DRUGS/ALCOHOL, SOFA
– SOFA CARRIES A 40X INCREASED RISK!!
– INFANT LACKS ABILITY TO CORRECT PROBLEM
BUNKBED:
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COMMON INJURY SOURCE
35,790 INJURIES PER YEAR
10 DEATHS PER YEAR
WORSE THAN INJURY WITH REGULAR BED
MOST COMMON: <6 AND COLLEGE AGE
HEAD AND NECK MOST COMMON
LACERATION, CONTUSIONS, CONCUSSIONS,
FRACTURES
• 4X RISK FACIAL INJURY
• 8X FISK OF UPPER EXT FRACTURE
BUNKBED:
• MECHANICS:
– CHILDREN FALL: HANDS OR FEET FIRST
– ADOLESCENT /ADULT: FEET “BUNK BED
FRACTURE” 1ST MT
– VERY SMALL CHILD: HEAD FIRST
• < 3: INCREASED RISK OF HEAD INJURY
• CONSIDER: FALL QUESTIONS AS FOR COUCH
CHRONIC “MESS” EXPOSURE
EFFECTS
PETS
(FROM ONE END TO THE OTHER)
ZOONOSIS
• CATS:
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CAT SCRATCH DISEASE (BARTONELLA)
PLAGUE (FLEAS)
Q-FEVER
CAMPYLOBACTER (GI)
LEPTOSPRIA (LIVER,KIDNEY,CNS)
SALMONELLA (GI)
PARASITES (WEIGHT LOSS, EYE, ASTHMA,FEVER)
RINGWORM (FUNGAL)
RABIES
LYMES
ZOONOSIS:
• DOGS:
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RABIES
PARASITES
CAMYLOBACTER
SALMONELLA
PLAGUE
LEPTOSPIRA
FUNGAL (SKIN RASHES)
LYMES
SCABIES
• BIRDS:
– PSITTACOSIS (PNEUMONIA, FEVER)
ZOONOSIS:
• REPTILES/AMPHIBIANS:
– TURTLES, SNAKES, LIZARDS, FROGS, SALAMANDERS
– SALMONELLA
– FISH TANK GRANULOMA
• MICE
– HANTAVIRUS (DEATH)
– LYMPHOCYTIC CHORIOMENINGITIS
• RABBITS
– TULAREMIA
ANIMAL BITE:
• HUNGRY
– SOILED DIAPER
• DEFENSE
– SUDDEN APPROACH
– HIT OR ANTAGONIZED
• AGED PET
– POOR HEARING OR VISION
– ARTHRITIS
– WOUND
• ACCIDENTAL
– KNOCKS OVER CHILD
TELEVISION
TELEVISIONS:
• 13,700 ER VISITS A YEAR
• PAST 12 YEARS ~ 170 DEATHS
• TV CHANGES:
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INCREASED SIZE
INCREASED WEIGHT
BASE SMALLER
ON COUNTERS, MEDIA CENTERS, DRESSERS
WEIGHT DISPROPORTIONATELY TO FRONT OF SET
MORE EASILY PULLED OVER
• MOST COMMON INJURIES:
– HEAD AND NECK INJURIES
TELEVISIONS:
• REASONS MORE CHILD INJURIES:
– YOUNGER CHILD SPENDS MORE TIME AT HOME
– LESS ABLE TO ANTICIPATE DANGER
– CLIMBERS
– INJURIES:
• FRACTURES, INTRACRANIAL INJURIES, RH, CHEST
CRUSH INJURIES, DEATH
BATHTUBS
AND BUCKETS AND TOILETS
WATER HAZZARDS:
• #1 NON-POOL DROWNING SITES (TUBS)
• SITES: TUB, TOILET, BUCKETS, HOTTUBS, SINKS
• HIGHEST RISK: <1 (AVERAGER 9 MONTHS)
• >90%: LAPSE IN ADULT SUPERVISION
• INJURIES: SLIPS, TRIPS, FALLS, (NEAR)DROWNING,BURNS
• HOT WATER HEATERS < 120
– INFANT SKIN IS NOT ADULT SKIN 156*
WATER HAZZARDS:
• INCREASED RISK:
– CHILD WITH SEIZURES (EPILEPSY OR FEBRILE)
– LEFT WITH OLDER SIBLING TO WATCH
• MUST CONSIDER NON-ACCIDENTAL
– LITTLE PHYSICAL EVIDENCE TO FIND
– LITTLE AUTOPSY EVIDENCE TO FINE
BURNS
STATISTICS:
• 2500 PEDIATRIC BURN FATALITIES/YR
• 40-80,000 BURNS TREATED YEARLY
40% ARE PEDIATRIC PATIENTS
PEDIATRIC BURNS
• CAUSED BY PATIENT
• INNOCENT BYSTANDER
• ABUSE/TORTURE
BURNS AND AGES
• INFANT
SCALDS
• TODDLER
SCALDS
CONTACT
ELECTRICAL
• SCHOOL AGE
SCALDS
CONTACT
ELECTRIC
FLAME
• TEENS
HIGH RISK BEHAVIOR
SELF MUTILATING/BRANDING
SUICIDE
STATISTICS (ABUSE):
• Usually < 10 yr old (majority < 2 yr old)
• 10% of all abuse cases are burns
• 10% of hospital admit for burn: abuse
• Abuse cases: younger
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longer hospital stays
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higher mortality rates
LEFTOVERS
FOOD POISONING:
• 48 MILLION ILLNESS PER YEAR
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• 128,000 HOSPITALIZATIONS PER YEAR
• 3,000 DEATHS PER YEAR
• COMMON BACTERIA: LISTERIA, E. COLI, SALMONELLA
• TOXIC AGENTS: MUSHROOMS, PESTICIDES ON FOOD
• HIGHER RISK: INFANT, FETUS, YOUNG CHILDREN, ILL
CHILD
KITCHEN UTINSLES
• KNIVES
• BROKEN GLASS
NICOTINE INGESTION:
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INGESTION OF TOBACCO OR SALIVA (CHEW)
WW2 USE
10-15MG NICOTINE/CIGARETTE; PATCH 5-22MG
IN CHILD: 1 CIGARETTE OR 3 CIG BUTTS = TOXIC!
DIRECT CNS EFFECT: VOMIT, SEIZURE
NAUSEA, VOMITING, ABD PAIN, DIARRHEA,
HYPERTENSION,
• TACHYCARDIA, HYPOTENSION, RESP MUSCLE
WEAKNESS
• MAY SEE DELAYED RESPONSE WITH PATCH OR
OTHER TOXINS:
• LEAD:
– SPICES
– TOYS
– MAKEUP
– FLOUR
– BE AWARE OF “CULTURAL”
VITAMINS:
• TOXICITY ASSOCIATED WITH
IRON, A & D.
• IN TOP 10 POISONINGS <6 Y/O
• REASON: ACCESSIBILITY
• CANDY APPERANCE/FRUIT
FLAVOR
• CHILD RESISTANT CONTAINERS
MEDICINES
OTC
PRESCRIBED
“PATCHES”
STRANGULATION INJURIES:
• INCRESED RISK: INFANT AND YOUNG CHILD
• POOR JUDGEMENT
• UNABLE TO RESPOND TO DANGER
• LEFT ALONE PLAYING
• RISKS WITH: TOYS, HIGHCHAIRS, PLANT HANGERS,
• ELECTRICAL CORDS, CRIB SLATS, BELTS, IV TUBING
EVALUATION AND PREVENTION:
• HOME INSPECTION
• EDUCATION
• REINFORCE (REMEMBER HAVING FREE = USING IT)
• INVESTIGATION:
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RISKS ?
THINK HOW A CHILD THINKS AND RESPONDS
DEVELOPMENTAL LEVEL OF CHILD
PHOTOGRAPHS (MANY!!!!)
ALWAYS CONSIDER NON-ACCIDENTAL AS POTENTIAL