Page 1

the

paediatric first aid training handbook David Olley

AED

14

Anaphylaxis

33

Asthma

28

Bites and Stings

54

BLS Child

6

BLS Infant

11

Bleeding

25

Burn Injury

44

Care of the Child

4

Choking

17

Croup

43

Diabetes

39

Documentation

59

Drowning

22

Electrical Injury

45

Emergency Response

3

Eye Injury

58

Febrile Convulsions

38

First Aid Kit

63

Fractures

48

Head Injury

49

Internal Bleeding

27

Meningitis

31

Recovery Position

15

Seizures

37

Shock

24

Sickle Cell

41


Contents

the

paediatric

first aid training handbook

Safety Publishing Ltd 483 Green Lanes London N13 4BS info@safetypublishing.co.uk www.safetypublishing.co.uk

AED

14

Anaphylaxis

33

Asthma

28

Bites and Stings

54

BLS Child

6

BLS Infant

11

Bleeding

25

Burn Injury

44

Care of the Child

4

Choking

17

Croup

43

Diabetes

39

Documentation

59

Drowning

22

Electrical Injury

45

Emergency Response

3

Eye Injury

58

Febrile Convulsions

38

First Aid Kit

63

Fractures

48

Head Injury

49

Internal Bleeding

27

Meningitis

31

Recovery Position

15

Seizures

37

Shock

24

Sickle Cell

41

Š2011 Safety Publishing Ltd. All rights reserved. No part of this publication may be reproduced in any form or by any means without the written permission of Safety Publishing Ltd


2 Paediatric First Aid The emergency plan Thankfully, when caring for children it is rare to have to give first aid for anything other than trivial accidents or injuries. However, on occasions accidents may occur or children may become ill and you may be called upon to offer first aid or even medical treatments. It is therefore very important that you plan for these events. You will need to develop your own emergency plan which meets your specific requirements. The plan should cover all situations that might occur when you have children in your care.

Points to consider Ÿ Access to a telephone, with a backup should the telephone be out of action. Ÿ The services of someone to care for the remaining children whilst you deal with the emergency. Ÿ Access to the following telephone numbers for you or someone else who may need to take action in an emergency: i. child’s parents (home and work numbers) ii. child’s gp and your own gp. iii. local health centre and local hospital. iv. emergency backup person. Ÿ Access to children’s individual record forms to take to hospital with the child or for someone else to use to contact the parents. Ÿ First aid kit. This should be properly labeled and quick and easy for others to find. Ÿ Have you completed an appropriate first aid course and do you have the knowledge and skills to react appropriately in an emergency? Ÿ Are parents aware of your emergency plan and what to expect if there is an emergency? Ÿ Are they aware of what would be expected of them?


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Paediatric First Aid The emergency response plan In any emergency it helps to have a clear plan of action. This helps you to prioritise your actions and to ensure that things are not missed. Make the area safe if possible. Do not take risks

Danger Yes

To yourself, the casualty or others

Find and treat other injuries.

No

Response Shout and shake

Yes

No

Call for medical attention if required

Shout “Help” but don’t leave the casualty

Airway open with head tilt / chin lift

Breathing Normally?

Yes

No10 secs. Check for

No

Give 5 rescue breaths

Start Resuscitation Give 5 rescue breaths and then continue CPR for one minute before going for help. Maintain CPR at 30:2 until help arrives

Perform Secondary Survey Place in Recovery Position


4 Paediatric First Aid Care of the child The most important objective of first aid is to keep the child alive. With this in mind your first priority is to find and treat any conditions that are immediately life threatening. Once you are happy that the child is not in any immediate danger you can assess them for less serious conditions and attempt to find out what has happened and how it has affected them.

Life saving first aid

A

Airway

B

Breathing

C

Circulation

Can they breathe? If they are unconscious open the airway with head tilt / chin lift (Page 7) If they are conscious treat conditions such as choking Are they breathing normally? If they are unconscious and not breathing normally give 5 rescue breaths and perform CPR for one minute before raising the alarm. If they are unconscious and breathing normally examine them for other injuries and place them carefully into the recovery position (Page 15) If they are conscious but have breathing problems such as Asthma treat this condition before moving to the next step. Are they bleeding or in shock? Control any serious bleeding (Page 25) and look for and treat the effect of blood loss or Shock (Page 24) Call 999 / 112 for an ambulance.

Airway As food enters the back of the throat it sets off a series of reflexes which cause the opening to the windpipe to be temporarily closed off, preventing the food from ‘going down the wrong way’. This is the swallow reflex. If this mechanism fails, the food may enter the top of the windpipe. This causes another set of reflexes to trigger which results in a forceful cough that blows the object clear. This is called the cough reflex.


Paediatric First Aid Airway (continued) These reflexes are lost in the unconscious child. This means that the airway is unprotected and that anything in the child’s mouth could drop into their windpipe and block it. This could include food, blood, saliva and most commonly, the tongue. As we become unconscious our muscles start to relax. The tongue is a muscle and as it relaxes it tends to fall to the back of the throat, blocking it. If the airway is blocked no Blocked airway oxygen can reach the lungs to be transferred to the blood stream. With no oxygen in the blood, tissues will begin to die.

Breathing The air that we breathe in contains around 21% oxygen. We keep enough for our own needs but still breathe out a mixture that contains about 17% oxygen. This is more than enough to sustain life and it means that we can use our expired air to keep someone else alive. When we blow our expired air into a child’s lungs, oxygen will be absorbed into their blood stream automatically, ready to be circulated.

Circulation Blood is circulated by the pumping action of the heart so if this action stops, no blood and therefore no oxygen reaches the tissues and the more sensitive cells, particularly in the brain, will start to die in just a few minutes. Where the pumping action has failed we may be able to restore some circulation by using the child’s own heart as a pump. We achieve this by rhythmically compressing the lower part of the chest where the heart is situated. As we compress the chest, blood is forced out of the heart and into the circulation. When compression is relaxed the heart resumes its normal shape, like a rubber bulb, refilling the chambers with blood ready for the next pumping stroke. As there would be no point in pumping blood that did not contain oxygen, chest compressions are normally combined with rescue breathing.

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6 Basic Life Support - Child Age definitions Infant:- Less than one year Child:- One year to puberty

Approach with CARE Make sure that there is no danger to yourself, the child or bystanders.

Check for RESPONSE Ÿ Speak loudly to the child, ask them to open their eyes. Ÿ Gently stimulate them by tapping them on the shoulder. Ÿ Never forcefully shake the child.

Ÿ Watch their face for signs of eye opening or movement.

If they RESPOND If the child responds by opening their eyes, speaking or trying to move: Ÿ keep them in the position that you find them. Ÿ check for other injuries and treat any conditions that are immediately life threatening. Ÿ send for help or raise the alarm.

Ÿ continue to monitor their condition until the arrival of trained help. If there is NO RESPONSE Ÿ Shout loudly for help


Basic Life Support - Child Shout for HELP Ÿ If someone is nearby ask them to wait as you may need their assistance.

Ÿ If you are alone, shout for help loudly to try to attract attention, but do not leave the child.

Open the AIRWAY Ÿ Place one hand on the child’s forehead and press gently downward. Ÿ Place the tips of the fingers under the bony part of the jaw to lift and support the chin.

Ÿ Rotate the head gently backward.

Check for NORMAL BREATHING Kneel next to the child with your cheek over their nose and mouth looking down the chest towards the toes. Ÿ Look – for chest movement. Ÿ Listen – for breath sounds. Ÿ Feel – for breath on the cheek. Ÿ Take no more than 10 seconds to check.

If they are BREATHING NORMALLY Ÿ Treat any immediately life-threatening injury. Ÿ Turn them into the recovery position as soon as it is practical to do so. Ÿ Continue to monitor until the arrival of help.

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8 Basic Life Support - Child If they are NOT BREATHING NORMALLY Ÿ Give five rescue breaths Give RESCUE BREATHS

Ÿ Ensure that the airway is open (head tilt – chin lift) Ÿ Pinch the soft part of the nose with the index finger and thumb of the hand which is pressing on the forehead. Allow their mouth to open slightly while still maintaining chin lift.

Ÿ Take a breath and place your lips around their mouth, ensuring that you have a good seal. Blow steadily into their mouth for about one second until you see the chest rise.

Ÿ Lift your head away whilst maintaining head tilt – chin lift and allow the air to come out of their mouth.


Basic Life Support - Child Airway obstruction If you have difficulty achieving an effective breath it probably means that the airway is obstructed. Ÿ Re-check their mouth and remove any obvious obstruction (do not use a blind finger sweep). Ÿ Make sure the head is tilted and the jaw is lifted properly. Ÿ Make sure you are making a good seal around the mouth. Repeat up to five attempts to give effective inflations. If unsuccessful move on to chest compressions.

Chest Compression - Child Ÿ Place the heel of one hand over the lower third of the child’s breastbone. Ÿ Lift the fingers to ensure that you do not press on the ribs. Ÿ Position yourself with your shoulder over the chest and with your arm straight. Ÿ Push vertically downward with enough force to compress the chest by one third of its depth. Ÿ In larger children or with small rescuers this may be done with both hands, as in adult chest compression. Ÿ Repeat at a rate of 120 compressions a minute. Ÿ Give 30 effective chest compressions.

9


10 Basic Life Support - Child Combine CHEST COMPRESSION and RESCUE BREATHING Ÿ After 30 chest compressions stop and give two more rescue breaths. Ÿ Alternate 30 compressions with two rescue breaths. If there is no response after one minute, and nobody has called for help, stop and dial 999 for an ambulance. Ÿ When you know that help is coming, continue with rescue breathing/chest compressions at a ratio of 30 to 2 until help arrives and someone takes over. Ÿ If there is more than one rescuer present, change over every two minutes. Ÿ Try to keep the chest compressions at a regular speed and depth.

Two Breaths

Thirty chest compressions


Basic Life Support - Infant Approach with CARE Ÿ Make sure that there is no danger to yourself, the baby or bystanders. Check for RESPONSE Ÿ Gently stimulate the baby by speaking loudly to them and by moving a limb or tapping them on the foot.

Never shake a baby! If they RESPOND If the baby responds by opening their eyes speaking or trying to move: Ÿ keep them in the position that you found them. Ÿ check for other injuries and treat any conditions that are immediately life-threatening. Ÿ send for help or raise the alarm.

Ÿ continue to monitor their condition until the arrival of trained help. If there is NO RESPONSE Ÿ Shout “HELP” and start A.B.C. Open the AIRWAY ŸPlace one hand on the baby’s forehead and press gently downward to rotate the head backward. ŸPlace the tip of one finger under the bony part of the jaw to lift and support the chin.

ŸBe careful not to overextend the neck. The finished position should be with the baby’s eyes pointing straight upward.

11


12 Basic Life Support - Infant Check BREATHING Ÿ Place your ear closely over the nose and mouth of the baby. Look down the chest towards the toes. Ÿ Look for movement of the chest or abdomen. Ÿ Listen for breath sounds. Ÿ Feel for breath on the cheek.

Ÿ Take no more than 10 seconds to check. If the baby IS BREATHING NORMALLY Ÿ Treat any immediately life-threatening injury. Ÿ Turn them onto their side as soon as it is practical to do so.

Ÿ Continue to monitor until the arrival of help. If the baby IS NOT BREATHING NORMALLY Ÿ If someone else is available send them to dial 999 to call an ambulance Ÿ If you are on your own start rescue breathing and chest compressions and continue for around one minute before calling the ambulance. Deliver five effective rescue breaths Ÿ Ensure the airway is open. Ÿ Take a breath and place your lips around the baby’s nose and mouth ensuring that you have a good seal. Ÿ Blow out gently into the baby’s mouth until you see the chest rise. Ÿ Lift your head away from the baby while maintaining head tilt – chin lift. and allow the air to come out of the baby’s mouth.


Basic Life Support - Infant Airway obstruction If you have difficulty achieving an effective breath it probably means that the airway is obstructed. Ÿ Re-check the baby’s mouth and remove any obvious obstruction (do not use a blind finger sweep). Ÿ Make sure that the head is tilted and the jaw is lifted properly. Ÿ Make sure that you are making a good seal around the baby’s mouth. Repeat up to 5 attempts to give effective inflations. If still unsuccessful move on to chest compressions.

CHEST COMPRESSIONS - infant ŸPlace the tips of two fingers over the lower third of the babies breastbone. ŸPress down on the breastbone to a depth of one third of the depth of the baby’s chest. ŸRelease the pressure keeping your fingers in contact with the baby’s chest.

Combine CHEST COMPRESSIONS with RESCUE BREATHING Combine rescue breathing with chest compressions in a ratio of 30 chest compressions to 2 rescue breaths. Maintain CPR until: Ÿ The baby shows signs of recovery. Ÿ Someone else takes over. Ÿ You become exhausted.

13


14 Basic Life Support - Infant When to go for HELP Ÿ It is vital to raise the alarm as soon as possible. Ÿ If there is more than one rescuer, one should start CPR whilst the other goes for help.

Ÿ If you are on your own, perform CPR for about one minute before going for help. It may be possible to take the baby with you to the telephone.

Defibrillation and children Thankfully it is rare to have to use an AED on a child. Their use however can be life-saving in some circumstances. Standard AEDs are suitable for use on children older than eight years and the rescuer should use the same procedures and techniques as for adults. Where it is likely that the equipment will be used on a child between the ages of one year and eight years of age then special paediatric pads should be available and should be used. These pads reduce the power delivered by the AED to a lower and safer level. To ensure good conductivity of electric shock through the heart, the pads should be positioned with one pad placed in the centre of the chest and the other directly opposite in the centre of the child’s upper back.


The Recovery Position Recovery position - child The aim of the recovery position is to maintain the airway by placing the child in a position on their side, with the head lower than the chest. This allows the tongue to fall forward and allows drainage of blood, saliva or stomach contents from the mouth, by gravity. If corrosive stomach contents were allowed to enter the windpipe and lungs either by gravity or breathing in, the effect would be to cause a rapid and often fatal inflammation of the lining of the lungs. The inflamed or burnt surfaces produce large amounts of fluid and the child can literally drown in their own body fluids. This problem occurs because the muscle (sphincter) at the opening to the stomach relaxes in unconsciousness allowing corrosive stomach contents to be regurgitated into the mouth. The following criteria should be met: Ÿ they should be placed on their side with the mouth lower than the chest, to allow for free drainage. Ÿ there should be no pressure on the chest. Ÿ the position should be stable and allow easy access to the airway. Ÿ it should be possible to return the child onto their back easily.

Method Ÿ Before attempting to move them make sure that there is nothing in the immediate area which may be dangerous. Ÿ Have a good look at them checking for obvious injuries, these may not prevent you from moving them but they may modify the way it is done. Ÿ Remove their spectacles if worn and any sharp or bulky items from their pockets. Ÿ Kneel beside them.

Ÿ Open their airway with head tilt/chin lift.

15


16 The Recovery Position Recovery position - child (continued)

Ÿ Take the arm nearest to you and place it at right angles to the body with the elbow bent and the palm of the hand uppermost. Ÿ Bring the furthest arm across the chest and place the back of the hand against the child’s nearest cheek, holding it there with your hand.

Ÿ With your other hand, grasp the furthest leg just above the knee and pull it up, bending the knee but keeping the foot on the floor. Ÿ Keeping the child’s hand against their cheek, pull on the leg to roll them towards you onto their side. Ÿ Adjust the upper leg so that hip and knee form right angles. Tilt the head back and open the airway. Ÿ Adjust the hand under the chin to keep their head tilted back. Ÿ Monitor breathing and pulse and periodically check the circulation in the lower arm. Ÿ If you have not already done so, raise the alarm.


17

The Obstructed Airway Choking The majority of choking events occur whilst the child is eating or playing, often when a carer is present. If these events are witnessed, treatment is usually carried out quickly whilst the child is still conscious. When a child chokes the immediate response is coughing. This is likely to be the most effective and safest way of removing the obstruction. If coughing is not effective however, or the foreign body completely obstructs the airway, treatment needs to be immediate. You might suspect choking on a foreign body if: Ÿ the child develops very sudden breathing problems. Ÿ there are no other signs of illness or other obvious explanation. Ÿ the child was playing with small objects or eating immediately prior to the event.

Choking - general signs Effective cough

Ineffective cough

Ÿ Loud cough.

Ÿ Silent or quiet cough.

Ÿ Able to speak or cry.

Ÿ Unable to speak or cry.

Ÿ Able to breathe before coughing.

Ÿ Unable to breathe.

Ÿ Fully conscious.

Ÿ Decreasing level of consciousness.

Ÿ Blue colouration (cyanosis). Effective cough - treatment If the child is coughing you do not need to do anything. The cough is the best way to clear the airway so encourage them to cough and monitor their condition continuously. If the cough becomes non-effective start treatment to clear the airway.


18 The Obstructed Airway Ineffective cough - treatment Ÿ Bend them forward. Ÿ Give five firm blows between the shoulder blades. Ÿ Check the mouth and remove any foreign objects. Ÿ If the back blows don’t work give five abdominal thrusts. Ÿ Stand behind them and place a fist over the upper abdomen beneath the rib cage. Ÿ Grasp the fist with your other hand and pull sharply upward and inward, up to five times. Ÿ Check the mouth and remove any foreign objects. Ÿ If this is unsuccessful, revert to back blows and repeat the cycle. Ÿ If the airway is still not clear call an ambulance and continue with the cycle until the ambulance arrives or the airway is cleared.

Ineffective cough - unconscious child Ÿ Place them on a firm flat surface. Call or send for help if possible, but do not leave the child. Ÿ Open the mouth and look for any obvious foreign object. Ÿ If you see one, attempt to remove it.


The Obstructed Airway Ineffective cough - unconscious child (continued) Ÿ Attempt to give five rescue breaths (make five attempts if necessary). Ÿ Give thirty chest compressions. Ÿ Re-check the mouth and remove any object which has been dislodged. Ÿ Give two rescue breaths. Ÿ Repeat the cycle for one minute. If unsuccessful: Ÿ call an ambulance Ÿ continue the cycle of 30 compressions to 2 breaths until the ambulance arrives

Ineffective cough - conscious infant Give five back blows Ÿ Lay the baby face down along one arm, supporting the head with the hand. Ÿ Make sure the head is lower than the body. Ÿ Give five blows in the middle of the baby’s back, using the palm of the other hand. Ÿ If the obstruction is relieved it is not necessary to give all five blows. Ÿ Check the baby’s mouth and remove any foreign material found.

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20 The Obstructed Airway Ineffective cough - conscious infant (continued) If back blows are unsuccessful, give five chest thrusts Ÿ Turn the baby over onto their back. Ÿ Feel for the breastbone with two fingers and place the fingertips about a fingers width above the point where the ribs meet. Ÿ Give up to five sharp downward thrusts, similar to chest compressions but sharper and at a slower rate. Ÿ Check the baby’s mouth for any foreign objects, which should be removed. If necessary repeat the sequence of back blows and chest thrusts three times and if still unsuccessful take the baby with you to the telephone and call an ambulance.

Ineffective cough - unconscious infant Ÿ Place them on a firm flat surface. Call or send for help if possible, but do not leave the baby. Ÿ Open the mouth and look for any obvious foreign object. Ÿ If you see one attempt to remove it.

Ÿ Attempt to give five rescue breaths. Ÿ Assess the effectiveness of each breath, if the breath does not make the chest rise re-position the head before attempting the next breath.


21

The Obstructed Airway Ineffective cough - unconscious infant (continued) If the chest does not rise: 타 Immediately start chest compressions combined with rescue breathing at a ratio of thirty compressions followed by two breaths. 타 When opening the airway to give rescue breaths check the mouth for obstructions and remove them if possible. 타 Repeat the cycle for one minute. If still unsuccessful, call an ambulance.

Airway obstruction - summary of actions Signs of choking

No

Effective cough?

Yes

Severe obstruction

Unresponsive

Encourage cough

Give 5 back blows

Attempt 5 breaths

5 abdominal thrusts (child)

Start CPR at 30:2

Continue to check for a change to ineffective cough or relief of obstruction

5 chest thrusts (baby)


22 Immersion Injury Drowning and near drowning Drowning is a significant cause of death and disability in children, second only to accidental injury. At least one third of survivors are likely to suffer from moderate to severe brain damage. Drowning is usually defined as death from asphyxia within 24 hours of submersion in water. Near drowning refers to survival (even if temporary) beyond 24 hours after a submersion episode. In immersion injury time is critical. The temperature of the water may also make a difference. Immersion in cold water (water temp less than 20 deg. C.) will often have a better outcome than immersion in warm water. Drowning may also be due to other factors such as a simple faint or possibly a seizure and may hide other conditions such as hypothermia. Whatever the cause the treatment should follow the three ‘R’s

R

Recognition Rescue Resuscitation

Immersion awareness Children love to play in and around water but can get into trouble frighteningly quickly. A child can drown in as little as 20 seconds and in just a few inches of water in such things as paddling pools, puddles or even baths, buckets or toilet bowls. For this reason children should never be left unattended or unobserved around water or in bathrooms. A drowning child may be unable to shout for help so look out for: Ÿ waving arms Ÿ head tilted back with the mouth open Ÿ floating face down in the water


Immersion Injury Immersion - rescue Although the temptation to jump in after a drowning child is very strong, unless you know the water is shallow or not dangerous to you it should be resisted. It will not benefit the child if you become a victim, particularly if you are the only potential rescuer. Shout to alert bystanders and get them to call the emergency services or call them yourself. If possible, lay down at the edge and try to reach, or use something like a stick or belt to extend your reach. If the child is conscious try to throw something buoyant to them. If you have to enter the water try to wade rather than swim and where possible take a buoyancy aid with you. If carrying them from the water try to keep them horizontal or even slightly head down to keep them from inhaling water.

Immersion - treatment Immediately upon rescue check to see if they are conscious and breathing. 타 If they are conscious make sure that they are kept warm and monitor their condition. 타 If they are unconscious but breathing place them into the recovery position to avoid inhalation of water. 타 If they are unconscious and not breathing start CPR with 5 breaths and maintain it at 30:2 for one minute before going for help. 타 Following immersion in cold water it can be difficult to tell if they are breathing normally or not, they will have all of the appearances of death. If in doubt start CPR and maintain it until you are relieved. All accidental immersion victims need medical attention, even though they seem to have made a good recovery or been unaffected. They may have inhaled small amounts of water and this can lead to a very serious breathing problem up to 24 hrs later. Avoidance is better than cure.

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24 Shock Shock- definition Shock is a condition which results from the failure of the circulation to supply oxygen and nutrients to the tissues and to remove waste products from them. It is often associated with a sudden drop in blood pressure. The low oxygen levels in the tissues results in impaired cell function, death of tissue and organ failure. In children the most likely cause of shock is fluid loss associated with bleeding or burns. Another cause may be a severe allergy to such things as an insect sting, or eating peanuts (anaphylaxis). In children with an existing heart problem it may be associated with poor heart function. Shock is always serious and requires urgent medical attention.

Shock - recognition Ÿ Appropriate history (cause).

Ÿ Cold and shivering.

Ÿ Pale cold clammy skin.

Ÿ Thirst or dry mouth.

Ÿ Cyanosis (blue tinge to face).

Ÿ Confused or disorientated.

Ÿ Rapid weak pulse.

Ÿ Nausea, vomiting.

Ÿ Rapid shallow breathing.

Ÿ Yawning & sighing.

Shock - treatment Ÿ Treat the cause i.e. control bleeding. Ÿ Give lots of reassurance.

Ÿ Keep them warm but do not apply any heat source such as hot water bottles.

Ÿ Lay them down and elevate their legs, if their injuries permit.

Ÿ Give nothing to eat or drink but moisten their lips if they complain of thirst.

Ÿ Loosen tight clothing at the neck and waist.

Ÿ Get urgent medical attention.


Bleeding and Blood Loss Bleeding When we discuss blood loss we are actually referring to blood lost from the circulatory system. We may therefore be talking about internal or external bleeding.

External bleeding This is the easiest to see and the easiest to treat. Blood will be visible, flowing from a wound on the surface of the body.

External bleeding - treatment Direct pressure: this is pressure which is applied directly over the bleeding point. It may be applied over a pad of absorbent material or directly by the fingers or thumbs. The aim of direct pressure is to slow down the flow of blood sufficiently and for long enough to allow the formation of a blood clot. Blood clotting takes place in 5 to 10 minutes in normal circumstances and for this reason pressure should be maintained for at least 10 minutes to be confident that clotting has taken place. The most common reason for the failure of direct pressure to work is the temptation to lift the dressing to check on progress every few minutes. As soon as it becomes available a clean dry dressing should be applied to the wound and held in place by a bandage, applied tightly enough to apply pressure to the wound but not so tightly as to interfere with the circulation of the blood below the bandage. Elevation: to reinforce the effect of pressure, wherever possible the affected limb should be elevated above the level of the heart to reduce blood flow, paying due consideration to other injuries.

25


26 Bleeding and Blood Loss Wound dressing Ÿ Select a dressing of an appropriate size for the wound. Ÿ Handle the dressing by the bandage, do not touch the face of the dressing, to keep it clean. Ÿ Tie the dressing firmly in place by knotting the two ends. If blood soaks through the dressing apply another dressing on top of the first. If blood soaks through the second dressing remove both and re-apply a new dressing, making sure that pressure is applied directly over the wound.

Minor wounds

Ÿ Wash carefully with clean water Ÿ Dry thoroughly Ÿ Apply a clean dry dressing Ÿ Make a record


Bleeding and Blood Loss Internal bleeding Internal bleeding occurs when blood is lost from the blood vessels but retained within the body, usually within one of the body cavities such as the skull, thorax, abdomen and large muscles. It may follow injury such as a fractured bone or penetrating wound or it may be as a result of illness. Internal bleeding may remain concealed or may subsequently become revealed by visible blood issuing from one of the body openings such as the mouth, nose, ears or rectum.

Internal bleeding - recognition Ÿ History, may include history of violent injury or medical condition. Ÿ Pain and tenderness over the affected area. Ÿ Bruising or discolouration over the affected area. Ÿ The appearance of blood at one of the body openings. Ÿ The signs of blood loss shock with no obvious external bleeding.

Internal bleeding - treatment Ÿ Assess the situation and deal with immediate danger. Ÿ Assess the level of consciousness and treat appropriately. Ÿ Lay the patient down with limbs elevated. Ÿ Reassure the patient and keep them calm. Ÿ Keep them warm and loosen any tight clothing. Ÿ Give nothing by mouth. Ÿ Get medical help as a matter of urgency.

27


28 Medical Conditions Asthma Asthma is a condition that affects the lungs. It is the most common chronic chest disease in children.

Normal Bronchiole

In an acute asthma attack the tiny air pipes which carry air to the air sacs in the lungs, become narrow due to inflammation of the lining and muscle spasm of the wall of the pipe. This leads to difficulties in passing air through the pipe, causing a feeling a tightness in the chest Asthmatic and difficulty in breathing, particularly in Bronchiole breathing out. As the air is forced through the narrow pipes it causes a whistling sound and this whistling or wheezing is quite characteristic. Most asthma sufferers will have been diagnosed by their doctors and will be receiving treatment in the form of drugs which suppress the condition (avoidance) and drugs which relax the spasm of the air pipes (treatment) These drugs are usually given in the form of an inhaler or puffer which squirts a mist of drug into the mouth, which is then inhaled into the lungs

Asthma - recognition Ÿ Known history of the disease.

Ÿ Coughing.

Ÿ Severe respiratory distress.

Ÿ Cyanosis or a blue tinge to the skin.

Ÿ Noisy whistling or wheezing breathing, particularly on breathing out.

Ÿ Anxiety and distress.


Medical Conditions Asthma - treatment Ÿ Place the child at rest in a sitting position, leaning slightly forward. Ÿ Reassure. Ÿ Encourage them to use their own medication as appropriate. Ÿ If the drug does not work quickly, repeat the dose. If it still does not work or if the attack is more severe than normal call an ambulance or take the child to an accident and emergency department.

Asthma - medication If a patient is having an acute attack they require a drug which will relax their spasm. This will be in a blue inhaler. Children over the age of about eight years will be able to use a normal inhaler but this requires careful timing between the release of the drug and breathing in.

Using an inhaler Ÿ Remove the cap from the mouthpiece and shake the inhaler Ÿ If you haven’t used the inhaler for a while make one spray into the air to make sure it is working Ÿ Take a few breaths and then breathe out Ÿ Immediately place the mouthpiece in the mouth between the teeth and make a seal around it with your lips Ÿ Start to breathe in slowly and deeply through the mouth and at the same time press down on the inhaler canister to deliver a dose of medicine Ÿ Continue to breathe in to make sure the medicine gets right into the lungs Ÿ Try to hold your breath for 5 to 10 seconds

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30 Medical Conditions Asthma - using a spacer Young children may find it easier to use a spacer. This is a hollow plastic cylinder into which the drug is squirted. The child can then breathe it in when they are ready.

Ÿ Push the mouthpiece of the inhaler into the end of the spacer Ÿ Breathe out and put the mouthpiece of the spacer into the mouth between the teeth ŸMake a good seal around the mouthpiece with the lips ŸPress the metered dose inhaler down once to release a spray of medicine ŸThe spray will be trapped in the spacer

Ÿ Breathe in slowly and deeply to draw the medicine into the lungs. Ÿ Hold your breath for 5 to 10 seconds and then breathe out slowly.


31

Medical Conditions Meningitis Meningitis is inflammation of the membranes which cover the brain. It can be caused by many things such as bacteria, viruses or fungi. Some bacteria that cause meningitis may also get into the bloodstream and cause blood poisoning (septicaemia) this is most often seen with meningococcal meningitis, causing meningococcal septicaemia. The time between being exposed to the bacteria and the appearance of the disease (incubation period) is usually 2 to 10 days. The incubation period for viral meningitis is up to 3 weeks. Once established the condition may progress very rapidly and may become life-threatening in just a few hours. Anyone suspected of having meningitis requires urgent medical attention. Recognition of meningitis can be difficult in the early stages as it can mimic the appearance of flu. The following signs do not appear in any particular order. Some may not appear at all.

Signs - infants Ÿ Fever – hands and feet may feel cold. Ÿ Not feeding – may vomit. Ÿ High-pitched whimpering or moaning. Ÿ Blank staring expression. Ÿ Pale blotchy skin.

Ÿ The baby may be fretful and dislike being handled or may appear floppy. Ÿ Lethargic or difficult to wake. Ÿ The soft spot on top of the baby’s head (fontanelle) may be swollen or tense.

Signs - older children Ÿ Vomiting, sometimes with diarrhoea Ÿ Fever, possibly with cold hands and feet Ÿ Headache, becoming very severe Ÿ Stiff neck, may be unable to touch the chin onto the chest

Ÿ Dislike of bright light Ÿ Pain in the joints, sometimes stomach cramps with septicaemia Ÿ Drowsiness or confusion Ÿ Fits or seizures


32 Medical Conditions Meningitis / septicaemia Anyone suffering from septicaemia may display all of these signs, but in addition may develop a distinctive rash. This may start anywhere on the body as a cluster of small red spots, like pinpricks. Left untreated the rash will spread and the pinpricks may join together to form purple blotches.

To decide wether a rash may be due to septicaemia, press the side of a clear drinking glass against the skin. Most rashes will fade under pressure but a septicaemic rash does not fade when you press on it.

Meningitis / septicaemia - treatment If you suspect a child or baby is suffering from meningitis, do not waste time or wait to see how they get on.

Ÿ Dial 999/112 for an ambulance or if appropriate take the child immediately to the nearest accident and emergency department. Ÿ Tell the ambulance controller or receptionist that you suspect meningitis and insist that the child is seen immediately. Do not take ‘no’ for an answer and be prepared to stand your ground and be insistent.


Medical Conditions Anaphylaxis Anaphylaxis is a serious and rapid allergic reaction, often involving more than one part of the body.

Anaphylaxis - triggers Children can be allergic to many things. Food:

especially nuts, fish or shellfish and many kinds of fruit such as strawberries, bananas, kiwi fruit and even tomatoes or potatoes

Medicines: particularly antibiotics, such as penicillin Insects:

particularly bees and wasps, where these cause problems in a part of the body which has not been stung. If you just get a large swelling at the site of the sting, this is probably not anaphylaxis

Anaphylaxis - recognition Ÿ Faintness or loss of consciousness, due to a very low or sudden drop in blood pressure Ÿ Swelling of the face and neck and of the throat, that may cause problems in swallowing and breathing. Ÿ Asthma symptoms. Ÿ Vomiting / stomach cramps / diarrhoea. Ÿ Tingling in the mouth and lips, particularly if the cause was food. Ÿ Sudden collapse due to airway obstruction or to the sudden drop in blood pressure (anaphylactic shock). Ÿ An itchy rash like a nettle rash, sometimes called hives.

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34 Medical Conditions Anaphylaxis - recognition (continued) Not everyone who suffers an anaphylactic reaction will have all of these signs and symptoms and the reaction can vary from very mild to very severe and may happen within seconds or could take an hour or more. It is probably safest to assume that anyone who has an anaphylactic reaction is in danger and to treat them all as serious. It can be difficult to tell if the child is having an anaphylactic reaction or if it is some other problem such as fainting, as they can be similar in the early stages. Anyone who feels faint with swelling or a rash starting quickly is probably having an anaphylactic reaction and should be treated for it.

Anaphylactic rash

Anaphylaxis - treatment There is only one treatment which is effective in all cases of anaphylaxis, regardless of cause and that is adrenaline (sometimes called epinephrine) given by injection. In severe reactions it is vital that the sufferer has an injection of adrenaline as soon as possible, as the earlier it is used the more effective it is likely to be. As giving injections is not a normal part of first aid this may not be available to you, however because the injected adrenaline is so important in anaphylaxis, children who have a history of severe reactions will often carry a special injection device known as an EpiPen or Jext which is preloaded with a single dose of adrenaline and delivers the injection automatically.


Medical Conditions Anaphylaxis - treatment (continued) This is available to parents, teachers and other responsible adults to administer to the child in an emergency and so could be available to child carers. Before using it an agreement must be reached between the child’s carer, the child’s parents and the child’s doctor concerning the circumstances in which the injector would be used, how it would be used and what appropriate training should be given. In a life threatening emergency anyone may administer the injection by following the instructions on the pen. For instructions on using the Jext injector see page 36

If adrenaline is not available or while you are waiting for it, the following first aid procedures should be carried out: Position the child If the child is tired or feels faint lay them down. If they do not feel faint but their face or throat is swelling, sit them up to help breathing and to avoid making the swelling worse. If they feel faint and their throat is swelling decide which is worse and treat accordingly. If they are sleepy or become unconscious, put them into the recovery position. Dial 999/112 for an ambulance An ambulance paramedic will be able to inject adrenaline as well as to give oxygen and other important treatments. They will also ensure rapid and safe transport to hospital. Be prepared to offer life support Remember the ABC of basic life support and be prepared to act accordingly.

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36 Medical Conditions Anaphylaxis - using the Jext injector

Grasp the Jext injector with your thumb closest to the yellow cap

Push the black tip firmly into your outer thigh until you hear a “click” confirming the injection has started

Pull off the yellow cap with your other hand

Place the black injector tip against your outer thigh at 90’ to the thigh

Hold the injector firmly in place against the thigh for 10 seconds (a slow count of 10)

Massage the injection area for 10 seconds Seek immediate medical help


Medical Conditions Seizures A seizure or fit is due to an electrical disturbance in the brain. Some people suffer from repeated seizures, a condition called Epilepsy, whilst others may only ever have one seizure. In some people it may be triggered by flashing lights, loud repetitive noises or even playing video games, whilst in others in may follow a blow to the head or high temperature in illness. It is characterised by a loss of consciousness and un-coordinated movements or spasm of some or all of the limbs. The head may be thrown back or may be tossed from side to side. Often the teeth are clenched and there may be foaming saliva around the mouth.

Seizure - treatment Ÿ Clear a space for the child to have the fit safely. Ÿ Cushion the head if possible to protect it from injury. Ÿ Allow the fit to follow it’s natural course. Ÿ Do not attempt to restrain the child in any way. Ÿ Do not place anything in the child’s mouth. Ÿ Once all movements have stopped, check the airway and place the child into the recovery position until they wake up naturally. Call an ambulance: Ÿ

if it is a first fit.

Ÿ if they have a second fit. if they are unconscious for more than ten minutes.

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38 Medical Conditions Febrile convulsions Sometimes very young children may have fits if their temperature becomes too high, usually over 39°C. These are called febrile convulsions and often happen at the start of an infectious illness such as flu. They are likely to affect children in the age range of six months to five years.

Febrile convulsions - recognition Ÿ The child will lose consciousness. Ÿ The body, legs and arms will go stiff. Ÿ The legs and arms start to jerk and the head may be thrown back. Ÿ The skin may be pale or even appear blue. Ÿ The convulsion lasts for a few minutes and gradually subsides. Ÿ The child will be limp at first and then normal colour and consciousness returns.

Febrile convulsions - treatment Ÿ Treat as for a seizure. Ÿ Let the convulsion follow it’s course, whilst protecting the child from injury or harm. Ÿ Place the unconscious child in the recovery position. Ÿ If the seizure is prolonged or the child suffers repeated seizures, dial 999 or 112 for an ambulance. Ÿ Always consult the child’s doctor following a seizure. Ÿ You can help to lower the child’s temperature by removing excess clothing or bed clothing and opening windows. It is not recommended to sponge the child’s skin with cold water as this may lower the temperature too quickly.


39

Medical Conditions Diabetes Diabetes is a condition where the child can not produce enough of the hormone insulin to regulate the sugar levels in the blood. It may start slowly with the changes happening over several weeks.

Diabetes - recognition Ÿ Thirst

Ÿ Headaches

Ÿ Weight loss

Ÿ Tummy pains

Ÿ Frequent urination

Ÿ Problems with behaviour

Ÿ Tiredness

Diabetes - ongoing care If the child has been diagnosed they will almost always be treated with insulin given by injection. The amount will be carefully worked out by their doctor or hospital team. Most small children will need frequent doses of fast acting insulin, older children may use a continuous insulin pump. The important thing in treating diabetes is to keep the sugar level in the blood stable, not too high or too low. If the levels are too high the child may experience the symptoms above, but if the levels drop too low it can have a much more sudden effect that can become rapidly life-threatening if not treated. This is called hypoglycaemia or hypo for short. It happens when the child has their insulin but doesn’t eat enough sugar to balance the effect. It can also happen if the child burns up a lot of sugar with exercise.

Signs of hypoglycaemia Ÿ Pallor.

Ÿ Rapid heartbeat.

Ÿ Dizziness or shaking.

Ÿ Confusion.

Ÿ A feeling of weakness or hunger.

Ÿ Convulsions.

Ÿ Irritability or even aggression.

Ÿ Loss of consciousness.


40 Medical Conditions Hypoglycaemia - treatment If you suspect that the child may be suffering from a low blood sugar, give them sugar immediately. This can be in the form of glucose sweets or tablets or sweetened juice or soft drinks (a can of normal soft drink contains around six teaspoons of sugar). If the child becomes very sleepy or unconscious an ambulance should be called. The ambulance paramedic may give glucose by injection into a vein or may inject Glucagon, a hormone that stimulates the production of glucose. A serious hypo should be treated in hospital.

Diet Children who are diabetic no longer have to eat strict diabetic diets but should be encouraged to eat healthy diets with lots of carbohydrate and fibre. The diet would be balanced with the insulin intake by the hospital team. It is important to make sure that the diabetic child is eating properly, missed meals can quickly lead to a hypo attack.

Exercise Physical activity is very important for the diabetic child and they should be encouraged to be as active as possible. Exercise can lower the blood sugar so if the child is very active it may be necessary to give extra bread or other carbohydrates to avoid this.

Monitoring blood sugar levels A Diabetic person will have the equipment available to monitor their blood sugar levels. Older children will be able to do this for themselves. Whether it is appropriate for other persons to do it for them should be discussed with parents and possibly the child’s doctor.


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Medical Conditions Sickle cell disease Sickle cell disease is a condition inherited Sickle cell from the parents, it will have been diagnosed at a very early age. Child carers need to be aware if there is a child with sickle cell disease in their care, and will need to discuss the child’s condition and care with the parents. Sickle cell is a condition which affects Normal red mostly children of African, Caribbean, blood cell Middle Eastern, or Asian descent. In sickle cell the chemical that carries oxygen in the red blood cells is formed wrongly and these blood cells, in some instances, can become rigid, unbending and take on a curved or sickle shape. This shape is difficult to pass through the small blood vessels and so the cells may Sickle cells clumping clump up and form a blockage. This leads to a lack of blood supply to the affected part of the body which is likely to cause serious pain and could lead to organ damage and death of tissue. Normal red blood cells This is known as a sickle cell crisis and can be extremely serious.

Causes of sickle cell crisis Different things may trigger a crisis in different sufferers but some known triggers may include: Ÿ dehydration, even if the child is not thirsty. Ÿ over-excitement. Ÿ extremes of temperature – too hot or too cold.

Ÿ cold weather. Ÿ cold drinks. Ÿ bumps and bruises. Ÿ Infections.


42 Medical Conditions Sickle cell crisis - recognition The most common symptom is pain. This may be very severe and may occur most commonly in hands, arms , legs, lower back and sometimes in the joints. Headaches, tummy aches and pains in the chest may also be seen. Little boys may suffer from priapism, a painful stiff penis although they may be too embarrassed to admit it. This could lead to serious problems later in life and must be taken seriously.

Sickle cell disease - general care The best thing is to try to avoid a crisis happening, so if there is a particular known trigger in an individual, take steps to avoid exposing them to it. Ÿ Make sure that they have plenty of drinks, even if they say they are not thirsty Ÿ Remember that they may have to go to the toilet more often as well. Ÿ Keep them warm and dry. Ÿ Make sure that they do not become overtired. Ÿ Be alert for signs of an infection. Ÿ Be alert for signs of pain. Ÿ Be aware that they may suddenly become unwell. An acute sickle cell crisis is a medical emergency. Dial 999/112 for an ambulance.


43

Medical Conditions Croup Croup refers to a group of conditions which involve inflammation of the upper airway and lead to a harsh “barking” cough. Croup is usually caused by a viral infection but may be caused by bacteria or even an allergic reaction. It most commonly affects children between three months and five years old and tends to be most severe in those under three years old. It is most common in the autumn and winter. Most cases of viral croup are fairly mild but it can become serious or even life-threatening. Children who were born prematurely or with narrowed airways and those with respiratory disease such as asthma are most likely to be affected.

Croup - recognition The condition often starts like a cold with a stuffy or runny nose and a slightly raised temperature. As the condition develops, the child’s voice may become hoarse and they may start to cough with the characteristic sharp barking sound. The condition becomes dangerous when the upper airway becomes swollen to the point where it is difficult for the child to breathe.

Signs of severe croup Ÿ Distressed or rapid breathing Ÿ Excessive movement of the belly when breathing Ÿ The skin between the ribs being sucked inward when breathing in Ÿ Noisy rasping breathing (stridor)

Ÿ Pale grey or blueish tinge, particularly around the mouth Ÿ Difficulty in swallowing or drooling Ÿ Inactivity / looks ill Ÿ Condition appears to be getting worse

Croup - treatment Treatment is generally to relieve the symptoms. Breathing in moist air often relieves many of the symptoms and sitting in a steamy bathroom often helps. If the child’s condition appears to be worsening they will require hospitalisation although most cases remain fairly mild. Sit the child in a comfortable position to aid breathing and reassure. Refer to medical attention if their condition is getting worse.


44 Burn Injury Burns and scalds Burns and scalds are a major cause of serious injury in children up to fourteen years old. Children under four years of age are at most risk, especially those aged between one and two years. Children burn very easily because their skin is very thin and fragile

Scalds Scalds are burns from hot liquids or steam. Any hot substances can scald a child, in fact everyday items cause the most scalds. These include hot drinks such as cups of tea and coffee, hot tap water, bath water, hot cooking oil, hot food, saucepans of hot liquid, steam and vapour. A severe scald can inflict serious injury and may mean a long stay in hospital. It may also require painful skin grafts and years of treatment and can result in permanent scarring. A severe scald over a large skin area can kill.

This scald was caused by a cup of tea.

Be very aware of the temperature of water coming from a hot water tap. Most scalds to small children happen in the bathroom and result from hot water tap temperature being too high. The average temperature of domestic hot water is 70°C. A much safer temperature for domestic hot water is 50°C. This is because water that is at a lower temperature takes longer to cause injury. Ÿ At 60°C it takes one second for hot water to cause serious burns Ÿ At 55°C it takes ten seconds Ÿ At 50°C it takes five minutes to cause serious burns Remember that the maximum bathing temperature recommended for young children is 37-38°C so cold water should be run into the bath first and then mixed with water from the hot tap to bring it up to a safe temperature.


Burn Injury Scalds (continued) Other measures to reduce the risk may include: Ÿ keep hot drinks and cup handles out of reach. Ÿ keep hot drinks away from the edge of the table or bench. Ÿ never carry hot drinks whilst children are playing underfoot. Ÿ give toddlers their own special mug so that they don’t drink from an adult mug or cup that may contain liquid that is too hot. Ÿ it is safer to serve cold drinks when children are present and to have your tea break when toddlers are sleeping.

Electrical burns Children may suffer electric shock from playing with or poking things into unguarded electrical sockets, or even from biting into electrical leads. Electrical burns may vary in severity from minor thermal burns to deep serious burn injury with multiple organ failure, unconsciousness and death. Electricity also poses a risk to the rescuer as well as to the victim. Do not attempt to touch the child until the source of the electricity has been disconnected. This may be achieved by switching off or unplugging the appliance (make sure that it is the correct switch or plug, in the heat of the moment it is easy to make mistakes). If the child has suffered a shock from very high voltage equipment found outside, do not approach them until you have been informed by a responsible person that the power supply has been switched off. High voltage electricity can jump a gap of at least ten feet so you don’t even have to touch it. What you should always do is dial 999/112 for an ambulance. Remember, you can not help the child if you have been electrocuted.

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46 Burn Injury Electrical burns - treatment Unconsciousness – if the child is unconscious:

see pages 4-5

Not breathing – if the child is not breathing:

see pages 7-12

No heartbeat – if the heart is not beating:

see pages 9-13

Burns If the child has suffered burns see the general treatment on this page but remember that all electrical burns, even small ones, require urgent medical attention. Other injuries The force of the electric shock may cause the child to be thrown some distance and they may suffer injuries to the head, spine or other parts of the body as a result. Sometimes the muscle spasm caused by the electricity may be so strong that it pulls on the bones hard enough to break them.

Burn injury - first aid Ÿ Deal with the source of the heat. Ÿ Cool the burn with clean cool water or other bland liquid for 15 minutes. Ÿ Remove constrictions around the burn before swelling becomes a problem. Ÿ Cover with a clean dry non-fluffy dressing. Clingfilm or polythene is ideal. Ÿ Anticipate and treat shock.


Burn Injury Burn injury - first aid (continued) Do not: Ÿ burst blisters. Ÿ use fats, ointments or creams on a burn. Ÿ use adhesive dressings or tapes. Ÿ touch the burn. Ÿ cough or sneeze on the burn. Ÿ remove anything which is stuck to the burn.

Do: Ÿ remove the source of the burn. Ÿ cool the burn, for at least 15 minutes. Ÿ cover the burn with a non-fluffy dressing.

Get medical attention for: Ÿ anything other than a very minor burn. Ÿ any electrical injury. Ÿ any chemical burn. Ÿ anything you are concerned about.

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48 Suspected Fracture Greenstick fracture Because children’s bones are softer and more pliable than adults, they tend to bend rather than break. Sometimes part of the bone breaks. This incomplete fracture is known as a greenstick fracture because it breaks like a green branch or twig. The general treatment for fractures is to avoid any further damage by keeping them still.

Suspected fracture - recognition Ÿ Deformity. Ÿ Pain at the site. Ÿ Tenderness at the site. Ÿ Swelling and bruising. Ÿ May be unable or unwilling to move the affected part.

Suspected fracture - treatment Ÿ Move the child as little as possible. Ÿ Keep the affected part in the position that you find it. Ÿ Stop the bleeding and cover any open wounds. Ÿ Do not apply splints or bandages to the affected part. Ÿ Any injury other than minor injuries to the hand or arm would require an ambulance.


Head Injury Head injury Head injuries can be divided into two types: Ÿ Concussion. Ÿ Compression. Both types of injury can result from a blow to the head or from sudden violent movement.

Concussion Usually results from a blow to the head or violent movement that causes the brain to be shaken and to be damaged by contact with the inside of the skull.

Concussion - recognition The effects are immediate and may include: Ÿ brief period of unconsciousness (a few seconds). Ÿ possible short-term memory loss. Ÿ nausea / vomiting. Ÿ weak / dizzy. Ÿ pale clammy skin. Ÿ rapid weak pulse. The effects are usually of short duration and the child will almost always make a good recovery, but: any child that is or has been unconscious must be seen by a medical professional as soon as possible.

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50 Head Injury Concussion - treatment Ÿ Assess consciousness, if unconscious check ABC. Ÿ Dial 999 for an ambulance. Ÿ Offer life support as appropriate. Ÿ Place a breathing unconscious casualty into the recovery position. Ÿ Continue to monitor vital signs. Most concussion victims make a rapid and full recovery with the only treatment required being rest and observation.

Compression injury Occurs due to swelling or bleeding inside the skull, following a blow to the head or violent movement such as shaking. This causes an increase in pressure within the skull leading to pressure being applied to the brain and localised brain damage. Over time the pressure rise will also prevent the heart from supplying blood to the rest of the brain.

Blood clot Brain

Compression injury - recognition Compression injuries are usually slow to become apparent. The child may appear fine immediately after the incident but their condition may worsen over the next few hours. The effects may include: Ÿ headache, getting worse over time. Ÿ skin is dry and warm. Ÿ child looks flushed. Ÿ deep sighing breathing.

Ÿ pulse is slow and strong. Ÿ pupils may look unequal. Ÿ decreasing level of awareness. Ÿ unconsciousness. Ÿ convulsions.


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Head Injury Compression - recognition (continued) Unequal pupils

Pupil reacting normally

Dilated pupil

Compression - treatment Ÿ Assess consciousness. Ÿ Give life support as appropriate. Ÿ Dial 999/112 for an ambulance. Ÿ If conscious, place in a half sitting position was head and shoulders raised. Ÿ Support the neck. Ÿ If unconscious, place in the recovery position. Ÿ Continue to monitor their condition and vital signs.


52 Poisons Poisons A poison is any substance which has a bad effect on the person exposed to it. The effect could be anything from a skin rash to a headache to sudden death. Most children are poisoned by swallowing poison substances such as plant material from the garden, other people’s tablets and medicines or cleaning materials. Depending upon the type of poison it may have to be absorbed from the digestive system and will then have its effect on different parts of the body (systemic poison) or it may burn the mouth and throat (corrosive poison) Another way for poison to enter the child’s body would be absorption through the skin following an accidental spillage, although this would be rare.

Corrosive poisons The major threat is from burns to the mouth and the airway. Ÿ Wipe or wash any residual chemical from the face and mouth. Ÿ Give frequent sips of water, milk or other bland liquid to wash the chemical from the mouth. Ÿ Do not make the child vomit as the chemical may burn on the way up. Ÿ Call a doctor and tell them what chemical is involved so that they can advise on appropriate treatment

If the child becomes unconscious Ÿ Call an ambulance. Ÿ Check ABC. Ÿ Be prepared to offer life support. Ÿ Place a breathing child in the recovery position.


Poisons Systemic poisons These may include tablets and medicines, alcohol or plant material such as toadstools or laburnum seeds. There may be a short delay between swallowing the poison and the start of symptoms as the poison is absorbed from the digestive system. Try to get as much information as possible about what has been swallowed, how much and how long ago. Try to obtain containers, bottles or samples of the poison. Call a doctor or ambulance and pass on this information so that they can advise on the correct course of action.

If they become unconscious: Ÿ call an ambulance. Ÿ check ABC. Ÿ be prepared to offer life support. Ÿ place a breathing child in the recovery position.

Absorbed poisons May result from spilling chemicals on the skin. If you suspect an accidental spillage wash as much chemical as possible from the skin with large amounts of water. Try to get as much information as possible about the chemical from containers, labels etc. Call a doctor or ambulance and pass on this information so that they can advise on the correct course of action.

If they become unconscious: Ÿ call an ambulance. Ÿ check ABC. Ÿ be prepared to offer life support. Ÿ place a breathing child in the recovery position.

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54 Bites and Stings Insect stings A sting occurs when venom is injected through a hollow tube into the skin or underlying tissue. Most insect bites and stings in the UK are likely to cause discomfort rather than danger but being stung or bitten is possibly painful and may cause the child to become distressed.

Insect stings - recognition

Wasp sting

Allergic response

Bee Sting

The most common stinging insects in the UK are the bee, wasp or hornet and the sting will often cause an immediate and possibly intense burning pain at the site, followed very quickly by swelling and redness around the sting. This will usually ease after a few hours. The biggest threat from such a sting would be a severe allergic reaction, or anaphylaxis (see page 33) A less serious allergic response may lead to localised swelling. This child had a wasp sting to the index finger that lead to swelling of the hand. The swelling and redness may spread to be several centimetres across or may even involve a whole arm or leg. It will usually go away over a few days. It is not dangerous unless it affects the airway but in severe cases it may cause blister formation or infection if the skin breaks down. A wasp will not usually leave its sting behind and may sting more than once but a bee’s sting is barbed and will remain in the skin, with its venom sac attached. It is important not to press on this as it will push more venom into the wound.


Bites and Stings Insect sting - treatment Ÿ If the child has been stung by a bee and the sting is still in the skin it should be removed as soon as possible. Delay could lead to more venom being pushed into the tissues, Ÿ It is important not to try to grip or Poison squeeze the sting as this may sac squeeze more poison from the sac. Ÿ The best method is to scrape the sting out using something like the edge of a card, the back of a knife or your fingernail. Ÿ If you see any signs of a general allergic reaction then get medical help urgently. Phone 999 for an ambulance. Be alert for swelling in or around the mouth and lips. Ÿ If the child has been stung multiple times they require the same urgent medical attention. Ÿ Apply a cold compress to the site. Ice or frozen peas wrapped in a cloth or a cold wet flannel. Repeat as required. Ÿ If there is a localised allergic reaction with swelling, redness and itching then they may benefit from an anti histamine either by mouth of as a cream or ointment, Check with their parents or Dr. Ÿ If there is a small local reaction (most commonly) then after the cold compress the itching and swelling will go away over time.

Insect bite A biting insect does not inject venom when it bites, but there is often an allergic reaction to the insect’s saliva. Some biting insects, such as mosquitos feed from blood and may inject an anti blood clotting agent which may increase the allergic reaction. Blood feeding insects may also carry and pass on other diseases, such as malaria in the mosquito and Lyme disease from ticks. Although rare in the UK remember that children may go on foreign holidays and visits and may have been mosquito bitten whilst away.

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56 Bites and Stings Insect bites Common biting insects include: Ÿ Gnats and mosqitos Ÿ Ticks Ÿ Fleas, lice and bedbugs Ÿ Flies and horseflies. It is quite common to suffer multiple bites or clusters of bites.

Insect bites - recognition Ÿ Insect bites are often painless at the time, although horsefly bites may be very painful. Ÿ A small itchy and red lump may form, as much as 24 hours later. Ÿ A weal ( a small fluid filled blister) may develop immediately after the bite but is usually followed by a small itchy lump up to 24 hours later. Ÿ If the allergic response is stronger there Mosquito bite may be an enlarged area of redness and swelling. Ÿ Sometimes the itching will lead to the child scratching the affected area and this can lead to infection, causing redness, swelling and heat a few days later

Tick bites Ticks are transferred to the skin from leaves or grass and cling onto the skin with their jaws. As they feed on blood their bodies swell, often taking on a grey appearance. Tick bites tend to be painless. Ticks may carry a germ that could go on to cause Lyme disease which can be very serious. For this reason anyone who has suffered a tick bite should receive medical attention. Early signs of Lymes disease is a rash developing at the site of the bite a few days later, along with a raised temperature Tick on skin up to a month after the bite.


Bites and Stings Insect bite - treatment Ÿ Insect bites can cause severe itching, particularly where there are multiple bites from such things as fleas or bed bugs. Ÿ Cool compresses can help in the early stages but there may be a requirement for antihistamine creams or ointments or Bedbug bites even tablets, check this with the Doctor. Ÿ Calamine lotion can be soothing on inflamed skin. Ÿ Observe the site carefully for redness or swelling for several days after the bite. This may be an allergic response or possibly skin infection, particularly if the child has been scratching a lot. Ÿ Ticks should be removed with a pair of fine tweezers. Ÿ This is probably best done by someone with experience as it is easy for the tick to break, leaving the head part embedded. This invariably leads to a localised infection at the site. Tick removal

Animal bite Most bites are inflicted by dogs and possibly cats. Even small animals can cause a nasty injury and large animals can be particularly dangerous. If the bite has broken the skin or drawn blood then : Ÿ Control bleeding and treat shock. Ÿ Wash small wounds with clean water. Ÿ Arrange for medical attention. There is always a risk of infection from a bite and in addition there may be a requirement for tetanus protection.

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58 Eye Injury Eye injury The eye is a very delicate organ and is easily damaged. For this reason, most eye conditions should be seen and treated by a medical professional. In addition, children may not like anyone to go near to their eyes and this may make them uncooperative, which could make the problem worse, so treatment is usually best left to an expert.

Eye irrigation This technique may be used to remove loose particles of dust or dirt, if the child will cooperate, but it must always be done in cases of corrosive material in the eye. 타 The head should be placed with the affected side downward. 타 Clean water or eye wash should be poured across the eye from the inside outward, allowing the water to run away safely. 타 Make sure that contaminated water is not allowed to enter the good eye.


Appendix 1 - Documentation Documentation Anyone who works with children will have to be aware of the range of documentation and record-keeping required. Some or all of the following documentation may be required:

Accident book An accident book is required to maintain a record of any accident or sudden illness that may happen to a child in your care. The following information will need to be recorded: i. child’s name. ii. age and date of birth of the child. iii. time and date of the incident. iv. location of the incident. v. description of what happened. vi. description of injuries sustained. vii. description of treatment given and outcome. viii. eventual disposal (home, doctor, hospital etc). ix. signature of person making the entry. The book should be countersigned by the parents or guardians when the child is collected to ensure that they are fully aware of the accident, any injury and any treatment that has been given. They should also be advised of any further or ongoing treatment required.

Existing injury form These would be used to record the fact that the child had an existing injury when taken into care. If possible, care staff should be notified of existing injury by the parent or guardian when the child is left and the record countersigned by the parent. If the injury is found after the parent has left, its presence should be recorded and witnessed as soon as possible.

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60 Appendix 1 - Documentation Existing injury form (continued) The following information would need to be recorded: 1. child’s name, age and date of birth. 2. date and time that the injuries were noticed. 3. description of the type and position of the injury in detail (use diagrams if required) 4. any other relevant information. 5. signature of the person making the record. 6. signature of parent or witness.

Medical record form This form should provide all of the relevant medical history of the child that would be required in any emergency situation. It should contain the following information: a. child’s name, age and date of birth. b. home address and contact details. c. any relevant medical history. d. immunisation record. e. names and contact details of the child’s parents. f. names and contact details of the person to contact if parents are not available. g. name and contact details of the child’s doctor. h. name and contact details of the child’s health visitor. i. details of any specific dietary requirements.


Appendix 1 - Documentation Medication authorisation form This form would be necessary if the parents require you to administer prescription medicines to their child. It should contain the following information: i.

child’s name, age and date of birth.

ii. name of the medication. iii. reason for the medication. iv. exact dosage to be given. v. how the medicine is to be given. vi. frequency of medication / time medication to be given. vii. when medication was last administered. viii. how the medication should be stored.

The form should be signed by the parent or guardian stating that they give consent for the medication to be given and also by the child minder or nursery nurse stating that they understand the instructions given. In addition all medications must be stored in original containers and clearly marked with the child’s name, name of the medicine, dose and frequency.

61


62 Appendix 1 - Documentation Medication flowchart

Do you have a signed parent / guardian consent form?

No

Yes Do you have the child’s name, address and date of birth and the name, address and telephone number of the child’s G.P.?

No

Yes Do you know why the medication is being given?

No

If there is a “no” answer to any of the questions:

Yes Do you know when the last dose was given and when the next dose is due?

Do not give the medication

No

No medication is to be given

Yes Do you know how the medication is to be given and are you trained to administer it?

No

Yes Is the medication stored correctly, properly labelled and in a proper container?

No

Yes Is the dose clearly marked?

Yes

Give the medication


Appendix 2 - First Aid Kit Requirements The minimum level of first aid equipment is a suitably stocked and properly identified first aid container. At least one container should be supplied for each premises. First aid containers should be clearly marked with a white cross on a green background and should protect the contents from dust and damp. They should contain only suitable first aid materials. The container and its contents should be checked regularly and any missing or out of date contents should be replaced. A stock of materials should be available at the workplace for this purpose

Suggested contents The following content list is the minimum suggested level of equipment. These are suggestions only and different or alternative equipment may be more appropriate in individual circumstances. 1 x Guidance Leaflet 20 x Adhesive Plasters 2 x No 16 Eyepad 4 x Triangular Bandage 6 x Safety Pins 2 x Large HSE Dressing 6 x Med HSE Dressing 2 x Gloves (Pairs) 6 x Wipes 5 x Double Sided Non Adherent Dress 5 x 5cm 1 x Microporous Tape 1.25cm x 10m 1 x Blunt/Blunt Scissors 5 x Sterile Non Woven Swabs 10cm x 10cm 1 x Tubular Gauze 1m (Finger Size) 1 x Plastic Finger Applicator If the first aid kit is also to be used in treating adult staff on site then you should include three pairs of latex free gloves and one face shield or pocket mask for rescue breathing.

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64 Paediatric first aid Notes


the paediatric first aid training handbook Contains simple, accurate and up to date information

Conforms to all latest guidelines Filled with clear, easy to follow illustrations and photographs Popular with instructors and students alike Ideal as an ongoing reference book

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