Tag Archives: 112

How to assess a paediatric patient’s mental status after a fall

How to assess a paediatric patient’s mental status

I think head injuries is one of the most common questions I get asked when teaching so here is some advice to help.

Copied from the EMS1.com website

HeadWound_300

Spend time with infants and toddlers to learn and understand ‘normal’ responses

With a sickening thud, my two-year-old’s head slammed into the concrete. Despite three stern parental warnings she leaped off the front step, landed on the ice, went airborne, and cratered into the sidewalk. I feared the worst — open head wound and traumatic brain injury — when I began my assessment.

Assessing mental status in infants and toddlers is more complex than adults because they generally can’t tell the date, time, precise location, or preceding events. Kids under two might not even be able to report their name when healthy. My wife asked my daughter, “Where are you?” She literally interpreted her question and answered, “Right here.”

These are tips for gauging the mental status of infants and children:

  1. Ask available parents and/or caregivers.

As they know the child, they can tell you if the child’s mental status is normal or abnormal.

  1. Know age-related norms.

Infants are generally pretty comfortable being around and handled by strangers. Toddlers are more likely to exhibit stranger anxiety. An older toddler should know basic things like their own name, age, where they live, and/or their parent’s names.

  1. Recall of recent activities and favourite things.

Toddlers can recall recent events like what they had for lunch or an activity they were just playing. Check longer term memory by asking a toddler about their favourite toy, game, or memory.

  1. Ask the child to perform a simple task.

Try things like touch your nose, cover your ears, close your eyes, or make a big mouth.

  1. Know normal.

Spending time around kids is the best way to learn what is normal. Take advantage of injury prevention programs or community education events to interact with infants, toddlers, and their parents. Ask questions to see what toddlers are normally able to answer on their own.

My daughter survived her fall with only a painful reminder to listen to her daddy. Although she had a wound that required a few stitches she had no altered mental status and no loss of consciousness. She was lucky and I was relieved.

Greg Friese

EMS1

When to and when not to refer a head injury to the Emergency Department (ED) / Accident & Emergency (A&E). There is no real answer to this one except if in doubt refer and let the ED triage staff decide. Below is a letter from the Royal College of Paediatrics and child health where it is recommended that under twos be seen in the ED.

Headinjuriesunder2s

Advice from the NHS is:

Minor head injuries are common in people of all ages and should not result in any permanent damage.

The symptoms of a minor head injury are usually mild and short lived. Symptoms may include:

  • a mild headache
  • nausea (feeling sick)
  • mild dizziness
  • mild blurred visionIf your symptoms significantly worsen or you develop any new symptoms after being discharged, you should return to A&E straight away or call 999 and ask for an ambulance.

There are a number of self-care techniques you can use to relieve mild concussion symptoms. If more serious symptoms start to develop, seek immediate medical treatment.

Some self-care techniques for mild symptoms of concussion are outlined below.

Treating concussion 

  • If you or your child experience these mild symptoms after a knock, bump or blow to the head, you won’t usually require any specific treatment. However, you should go to your local accident and emergency (A&E) department for a check-up.
  • apply a cold compress to the injury to reduce swelling – a bag of frozen vegetables wrapped in a towel could be used, but never place ice directly on the skin as it’s too cold; apply the compress every two to four hours and leave it in place for 20 to 30 minutes
  • If you or your child experience minor symptoms after a knock, bump or blow to the head, you won’t usually require any specific treatment.

You should visit your nearest accident and emergency (A&E) department if you or someone in your care has a head injury and develops the following signs and symptoms:

  • loss of consciousness, however brief
  • memory loss, such as not being able to remember what happened before or after the injury
  • persistent headaches since the injury
  • changes in behaviour, such as irritability, being easily distracted or having no interest in the outside world – this is a particularly common sign in children under five
  • confusion
  • drowsiness that occurs when you would normally be awake
  • loss of balance or problems walking
  • difficulties with understanding what people say
  • difficulty speaking, such as slurred speech
  • problems with reading or writing
  • vomiting since the injury
  • problems with vision, such as double vision
  • loss of power in part of the body, such as weakness in an arm or leg
  • clear fluid leaving the nose or ears (this could be cerebrospinal fluid, which surrounds the brain)
  • sudden deafness in one or both ears
  • any wound to the head or face

First Aid Box Contents Update 15

3d small people - secret

1. There is no mandatory list of items to be included in a first-aid container. The decision on what to provide will be influenced by the findings of the first-aid needs assessment. As a guide, where work activities involve low hazards, a minimum stock of first-aid items might be:

  • a leaflet giving general guidance on first aid (for example, HSE’s leaflet Basic advice on first aid at work);
  • 20 individually wrapped sterile plasters (assorted sizes), appropriate to the type of work (hypoallergenic plasters can be provided if necessary);
  • two sterile eye pads;
  • two individually wrapped triangular bandages, preferably sterile;
  • six safety pins;
  • two large sterile individually wrapped unmedicated wound dressings;
  • six medium-sized sterile individually wrapped unmedicated wound dressings;
  • at least three pairs of disposable gloves (see HSE’s leaflet Latex and you6).

Attached is a Pdf list for the suggested workplace and travel kits.

First Aid Box Contents 15

Looking after Children during heat waves

 

Heatguide

New guide from Public Health For England. Advice for EYS for children in a Heat wave.

Looking_After_Children_Heat_PHE_AC_AB_Publications_MP_JRM_FINAL

Click the above link to download the pdf document or follow the link below to go to the website. There is also a document available for Adult care.

https://www.gov.uk/government/publications/heatwave-plan-for-england

 

 

 

EFAW Book update

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Slight change to your recent book if you attended a Emergency First Aid at Work(EFAW) course with me in the last 12 months

AED Data Collection

The Resuscitation Council (UK) no longer supplies or collects the AED event form that has been in use. Out-of-hospital cardiac arrest remains an important priority for the Resuscitation Council (UK) and it has established a national out-of-hospital database with the British Heart Foundation and Association of Ambulance Medical Directors, in partnership with the University of Warwick. This audit also captures the events where a public access AED has been used before the arrival of the ambulance crew via a reusable and easily accessible new online event form. To that end, there is a requirement to reflect this information within the suite of Highfield First Aid books.

The required changes are below.

Page 9

The book states the following:

‘In cases where a defibrillator has been used, regardless of whether shocks were given or not, then the Event Report Form (ERF) requires completing in full and the white copy to be sent to the Resuscitation Council (UK) as soon as possible. The address of which can be found at the bottom of the form.’

This paragraph requires removing and the following inserted:

‘In cases where a public access AED has been used, dependent on local authority policies, there may be a requirement to report the event using a prescribed audit reporting chain’

 

Thank you

 

PK

Slight update to your FAW book.

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Slight change to your recent book if you attended a  First Aid at Work (FAW) course with me in the last 12 months

AED Data Collection

The Resuscitation Council (UK) no longer supplies or collects the AED event form that has been in use. Out-of-hospital cardiac arrest remains an important priority for the Resuscitation Council (UK) and it has established a national out-of-hospital database with the British Heart Foundation and Association of Ambulance Medical Directors, in partnership with the University of Warwick. This audit also captures the events where a public access AED has been used before the arrival of the ambulance crew via a reusable and easily accessible new online event form. To that end, there is a requirement to reflect this information within the suite of Highfield First Aid books.

The required changes are below.

Page 7

The book states the following:

‘In cases where a defibrillator has been used, regardless of whether shocks were given or not, then the Event Report Form (ERF) requires completing in full and the white copy to be sent to the Resuscitation Council (UK) as soon as possible. The address of which can be found at the bottom of the form.’

This paragraph requires removing and the following inserted:

‘In cases where a public access AED has been used, dependent on local authority policies, there may be a requirement to report the event using a prescribed audit reporting chain’

 

Thank you

 

PK

British Standard First Aid Kit

Child First Aid

Here is the law as revised recently in relation to First Aid Kits.

Health & Safety (First Aid) Regulations 1981 (revised 2013).

“An employer shall provide or ensure that there are provided such equipment and facilities as are adequate and appropriate in the circumstances for enabling first aid to be rendered to his employees if they are injured or become ill at work.”

You have a choice when it comes to kits. You can buy an expensive kit to BS8599 standards or you can have a kit that meets the minimum that the HSE recommend. It is your choice.

Your kits must be based on your ‘First Aid Needs Assessment’

How to make sure you meet the new BS8599-1 Standard…

  1.  Undertake a First Aid needs assessment:

LOW RISK (e.g. shops, offices, libraries etc.)

HIGH RISK (e.g. light engineering and assembly work, food processing, warehousing, extensive work with dangerous machinery or sharp instruments, construction, chemical manufacture etc).

 

  1.  Based on risk, choose the appropriate British Standard First Aid Kit:

SMALL KIT USAGE GUIDELINES

LOW RISK   Less than 25 employees

HIGH RISK   Less than 5 employees

MEDIUM KIT USAGE GUIDELINES

LOW RISK   25-100 employees

HIGH RISK   5-25 employees

LARGE KIT USAGE GUIDELINES

LOW RISK     1 Large Kit per 100 employees

HIGH RISK     1 Large Kit per 25 employees

Remember Its your choice on the type of kit.

What does the HSE say?

“Employers may wish to refer to British Standard BS8599 which provides further information on the contents of workplace first aid kits. Whether using a first aid kit complying to BS8599 or an alternative kit, the contents should reflect the outcome of a first aid needs assessment”

Hope this helps

 

Again you can email me on paulkenny@me.com

 

PK

Checking First Aid Kits (UK)

Green first kit equipmentWhen ever children and adults are on site and whenever they leave the building on official duties or trips they must have access to a first aid kit. This also relates to solo workers.

There are no set guidelines for checking kits, however it is advisable to check them on a regular basis to ensure they are fully stocked.

Planning frequency depends on use. A review of your accidents over the last twelve months for your first aid needs assessment will tell you how often each box or bag is used and it should highlight the type of accidents you are dealing with. Each box/bag is stocked with items that reflect this audit.

There is a recommended minimum for your kits which is shown on my website www.paulkenny.me This list is also available from the HSE website.

There are two lists:

When checking kits, the contents should be:

  • Within the use by date
  • Still sealed
  • Packaging intact
  • Stocked to match the number of bodies on site
  • Is water available close to the kit?

You can have what ever you want as long as you justify it with evidence from previous incidents.

Remember no pills, creams or potions.

Water needs to be available at all times so wall kits need to be mounted near or in the same room as a sink and portable kits need a small sealed, sterile water bottle. ‘Still’ water bottles with a sports nozzle are ideal but remember it needs to be sterile and sealed. Also if it is a bottle of water it needs a sticker on saying for First Aid or HSE use only.

As a company we check our first aid kits every Monday and record in each kit a completion list on a monthly checklist. Each week a different member of the team checks the kits as each one has additional items as well as the HSE Minimum to meet that area of use. By doing the rotation on staff checks, all staff get familiar with the kits in that room or area.

Each kit has copies of blank accident forms and Patient report forms as well as the monthly check tick sheet. We also have a monthly treatment spreadsheet for minor injuries where wipes or plasters are used and don’t need a full accident form. On playground duties this spreadsheet will be daily and must be stored in a folder in the office. The only people to access this should be recognized first aiders.

As a busy first aid company we check fixed wall kits weekly and our portable kits daily.

If you have mobile kits used everyday on playground duties then these should be checked daily and a small amount of regular used stock need to held on site. Don’t hoard dressings as they usually only have a short 3 to 4 year shelf life.

If you are a venue that does not have many incidents the minimum really should be monthly.

I have not mentioned the BS8599-1 kits here and will cover this in my next update.

Hope this helps.

Email me on paulkenny@me.com for any information you need.

PK