Currently browsing medical emergency posts

Summer and Animal Bites: A Pediatrician’s Perspective Part II

RattlesnakeLet’s deal with animal bites, much more common in Summer than any other time of year. These summer tips can help keep your child safe. Of course the most common types of bites that are for the most part preventable are those due to cats and dogs.  These are the most common animals known to children but they must understand that the cats and dogs in their own homes are different than the stranger animals they may encounter  outside the home. They cannot just assume that these are as friendly as their own pets and just be taught the proper way to approach such animals.  Always from the front and never from behind, and allow the cats or much more frequently dogs to “learn” who they are by first presenting the back of their hand to the animal in a slow  movement.  If the dog seems to back away or puts his ears and tail down, your child should know to back away also. (Here’s a great post by our Kids and Canine’s Expert on how to Recognize a Dog’s Body Language Before Your Child is Bitten

Most dog bites in young children occur on the face and upper body making them far more significant than a bite on the arm or the leg. If a bite occurs from an animal that is unknown to your family and disappears from the scene, or the attack is totally unprovoked, you should bring your child to his/her Doctor for appropriate treatment and information. Because a cat bite is more like an “injection” through the skin because of needle like cat teeth, these tend to be more worrisome and might get infected more frequently than bites from dogs, but severe bites from either need to be seen by a Doctor and can result in permanent scarring, physically and emotionally.

Other bites should be totally avoidable if your child is taught never to approach a wild animal, anywhere!  Remember that certain animals are nocturnal feeders and therefore are seldom seen during the day.  If you see a raccoon or opossum wandering around during the day, stay away, this is not normal behavior and may signal disease in that particular animal (possibly rabies). Snakebites can be a serious problem, but most species of snakes suburban families will encounter are non poisonous, although they can inflict a bite that can them become infected- so again the best preventative is to steer clear of these animals.  Contact with poisonous snakes does occur, however with such activities as hiking, etc.  So hikers and their families should be educated about the likelihood of encountering snakes, bears, and mountain lions, and what to do under those circumstances. This does not mean that children should not take part in these outside activities but with parental guidance these are very important part of your child’s education and affords another active opportunity to enjoy mother nature.

FIRST AID for those encountering the previously mentioned contacts:

For snake bites of any kind, hold the extremity elevated above body level and resist the temptation to place a tourniquet on the extremity or to cut near the area and try to suck out the venom.  These are not only ineffective but can actually make things worse.  Things to do are to:

  • Call 911 and place ice on the extremity if you have it, but remember NO ICE on small extremities; fingers toes, ears, nose, etc.
  • If it is possible (and safe), try to kill the snake and bring with you to ER!!
  • Try to keep your child calm (if you can yourself calm down).

As far as other wild animal bites, if they are large and bleeding heavily, place pressure over the area and hold tight until help arrives. And again if you can (safely) bring the animal carcass with you to ER it would be very helpful.

For smaller animal bites not bleeding very much, rinse well with soap and water and contact your child’s Doctor or local ER.

If you end up going to an ER , call ahead as you drive there to let them know what the problem is.

Urgent Care or ER for Kids? Resources to Help Decide

My husband recently had an “incident” with one of our dogs, Nelson, and ended up being bitten. Now I should clarify that we have two wonderful dogs who are both very sweet and are absolutely full members of the family. Nevertheless, Nelson, – who we’ve had since he was a puppy – weighs in at 100 pounds and is EXTREMELY fond of food, or anything remotely resembling or smelling of food.

urgent care doctor helping boyThis incident happened because Nelson got a food soaked paper towel and had retreated with it under a corner table – his usual “safe” space. My husband got plenty of doggy warnings not to come near – and yet he insisted on trying to drag Nelson out and get the paper towel. The result was a series of impressive and bloody puncture wounds on his fingers. This was also rather ironic since he’s known among family and friends as the “dog whisperer” – and was rated as such in a quiz from an excellent post on dog bites which ran on this site last November.

As a result, he spent over an hour in the ER getting checked out, filling out paperwork about our dog, and…incurring over $600 in costs to us. It was only later, when we took our son to our local Urgent Care center for a sprained ankle, that it occurred to us that maybe Urgent Care could have taken care of the dog bite issue. My husband went to the ER because he thought he might need stitches. In the end he didn’t need them – but it turns out that our Urgent Care does stitches for minor cuts and injuries – at a much lower cost. If we’d only known this, he would have gotten the care he needed for about $500 less!

Given this incident, it seemed like a good idea to take stock of what Urgent Care typically offers, especially with respect to children. Urgent care is ideal in “non-emergency situations” for after-hours care or when you can’t get in to see your regular doctor. But what is “non-emergency”?  Apparently a minor broken bone is non-emergency, since our Urgent Care handles these and has onsite x-rays. But it’s not always so easy to determine the difference between “urgent” and “emergency”.  Thankfully some excellent web resources can help with that. The Children’s Hospital Colorado has a nice overview of when go to urgent care versus the emergency room. Head straight to the ER if your child’s skin or lips have turned blue, your child is unresponsive or difficult to arouse, or your child is having serious trouble breathing. Urgent care can usually handle simple cuts, injuries or illnesses – including fractures (unless the bone is sticking out!). The full guidance can be found on their website.

Seattle Children’s Hospital has a very handy review on their website, listed by condition or issue – and they have a nice downloadable version which you can print out (scroll down to the bottom of their webpage). Further below is a snapshot of some of the guidancethey provide.

Buyer Beware

One thing I learned from my research on this topic is that the services offered by Urgent Care centers are not yet standardized, especially for children. This is essentially a new industry and the rapid growth of these types of centers has spawned – as described by a doctor at Johns Hopkins in this article – “a mishmash of clinics, some offering fairly sophisticated care, while others providing only the most rudimentary.” And general Urgent Care centers are sometimes uncomfortable treating more serious pediatric concerns. This field is so new that the American Academy of Pediatrics only just established a sub-committee on pediatric treatment in urgent care in 2015. So, probably the best advice is to check out what services your local Urgent Care center provides – ideally in advance of needing them! – and follow your instinct if you think the ER is really the better bet.

urgent care guidance

CPR Training Required for High School Graduation

CPR in Irelands schoolsI know it is summer and the last thing any of us want to think about is school and all the work our kids have to put in to graduate.   If you are the parent of a high school student that is trying to figure out what courses will be best to take and what will be needed to ensure graduation then looking ahead to this upcoming school year and the growing movement of required CPR training in schools for graduation is a must.  Currently 24 states have legislation that require high school students take the CPR training in the school to be eligible to graduate and many more states have pending legislation on the way.

The American Heart Association statistics tell us that every hour in the United States 48 people will suffer an out of hospital cardiac arrest and that 9 out of 10 of those people will not survive, however if proper CPR measure are begun by a trained bystander then the odds of that person surviving can double or even triple; and since these people are suffering a cardiac arrest outside of a hospital this means they will be having them in every day situation like being at work, home, school, and places where care would normally take too long.   Having many more trained people in these everyday places can have an immediate impact and help save lives now.     The program that is teaching the CPR program in the schools is called “CPR IN SCHOOLS” and is monitored by the American Heart Association and can be found online at www.heart.org/cprinschool.

The bottom line is that there is never a bad time to learn CPR because you have no idea when you will need to use it and whether or not your children are required to take it in school, it is always a worthy investment that can pay dividends long after your children have graduated and who knows, the life they save may be yours.

Thank you and Have a Great and Safe Summer.

Photo credit: Northern Ireland ExecutiveCC license

What Should I Do If A Baby Is Choking?

If a baby is choking, you need to assess the situation quickly to see how best you can help.

This information applies to babies aged under one year old. For information relating to adults and older children, see What should I do if someone is choking?

Choking happens when a person’s airway suddenly gets blocked so they cannot breathe. Their airway can be partly or fully blocked. In babies, choking is often caused if they put small objects in their mouths, which then get stuck. It can also be caused by food getting stuck.

Mans arms holding a baby dollChoking in Babies Under One Year Old

A baby who is choking will be distressed and may be unable to cry, cough or breathe.

  • Lie the baby face down along your forearm or thigh, with their head low. Support their head.
  • Give up to five firm slaps to the baby’s back between the shoulder blades with the heel of your hand. (The heel is between the palm of your hand and your wrist.)
  • Stop after each slap to check if the blockage has cleared. Look inside the baby’s mouth and remove any obvious blockage. Do not poke your fingers into the baby’s mouth unless you can see and reach the blockage. You may push it further in.
  • If the airway is still blocked, give up to five chest thrusts (see below).
  • Stop after each thrust to check if the blockage has cleared.

If the baby’s airway is still blocked after three cycles of back slaps and chest thrusts, you should:

  • Dial 999 (UK) or 911 (US) for an ambulance immediately. Do not leave the baby – take him or her with you to the phone
  • Continue with the cycles of back slaps and chest thrusts until help arrives

Chest Thrusts for Babies Under One Year Old

In babies under one year old, chest thrusts are used in an emergency to clear a blockage from their airway. Important: do not use abdominal thrusts with babies under one year old.

  • Lie the baby along your forearm on their back, with their head low. Support their back and head.
  • Give up to five chest thrusts. Using two fingers, push inwards and upwards (towards the head) against the baby’s breastbone, one finger’s breadth below the nipple line.
  • Check if the blockage has cleared after each thrust, by looking inside the baby’s mouth and removing any obvious blockage. Do not poke your fingers into the baby’s mouth unless you can see and reach the blockage as you may push it further in.

Complications

Once the baby’s airway is cleared, some of the material that caused the blockage can sometimes remain and cause complications later. If the baby still has a persistent cough or difficulty swallowing, they need to see a health professional urgently. You should take the baby to A&E, an NHS Walk-in Centre or your GP if it’s during GP hours (UK).*

*In the US, take the baby to the ER, an urgent care clinic, or your primary care physician, if during office hours.

Further information:

Children and Accidental Poisonings: What You NEED to Know

?????????????????Keeping your children safe, this is the goal of every parent. We all want to keep our children safe and secure and help them live to their full potential but with over 300 children a day in the United States ages 0 to 19 being treated in emergency departments, and two children dying, as a result of being poisoned, the concerns of children and accidental poisonings are more prevalent than ever. These concerns are always the topic of extended discussion during our training classes both here at the fire department and in our community training classes and come down 3 main points.

  1. Precautions
  2. Identification
  3. Action

1. PRECAUTIONS.

Taking the steps before something bad happens is always the first step in any plan to keep children safe. Children are naturally curious and don’t yet know the dangers involved with chemicals and may easily confuse a glass cleaner or floor cleaner with their favorite drinks as well as confusing medicines and pills for candy. Properly Storing and locking away chemicals and medicines in special child safe storage containers is one of the best ways to keep naturally curious children away from these dangers. Along with securing chemicals, knowing who to call in an emergency is key as well. Placing emergency numbers around all phones and in all cell phones is a great precaution to take as well. 9-1-1 is always an easy number to remember but placing the number for the national poison control centers 800-222-1222 and any other numbers and information is advised as well.

2. IDENTIFICATION.

Identifying the signs and symptoms of a child that has a definite or suspected poison ingestion are of the upmost importance. Some of the signs of poisoning: Besides finding an open container or bottle, look for these signs if you suspect your child has swallowed something dangerous:

  • Burns or redness around the mouth and lips (a sign your child drank something caustic)
  • Breath that smells like chemicals
  • Burns, stains, and smells on your child, her clothes, or elsewhere in the house
  • Vomiting, difficulty breathing, sleepiness, confusion, or other strange behavior
  • Drowsiness, Dizziness, or weakness
  • Breathing problems
  • Rashes
  • Blue Lips or Skin ( cyanosis )

 3. ACTION.

If your child is awake and stable:

  • Remain Calm.
  • Don’t give ipecac syrup or try to make them throw up — doctors say this can do more harm to your little one. Instead, call the poison-control center at 800-222-1222
  • Tell the person who answers as much information as you know: What you think your child swallowed, when, and how much. (It helps if you have the bottle that contains the poisonous substance.) Then follow instructions on what to do.
  • If the poison-control expert tells you to go to the ER and you have the substance container, then take that with you to show the ER doctor exactly what your child ingested. Calling 9-1-1 is recommended in an emergency, driving to the ER is not recommended in an emergency due to the lack of focus on the road and the increased possibility of accidents.

 If your child is unconscious and not breathing:

  • Call 9-1-1 and give the information requested
  • Start CPR and wait for Emergency response.
  • Do NOT attempt to drive to the ER.

There is no way to prevent every possible scenario, but it is possible to be prepared in case of an emergency and as always, a little preparation goes a long way.

Be Safe

Greg

Administering Pediatric Safety for Childhood Emergencies

Editor’s Note:  While we would love to take credit for all the terrific information included in this post …(and of course are incredibly flattered that our name appears in the title)…in truth, we had nothing to do with the creation of this wonderful infographic.  All credit (along with our thanks) goes to Adams Safety Training.  

Administering Pediatric Safety - InfoGraphic

« Previous PageNext Page »