Connecticut School Nurses AssociationManagement of Orthopaedic Injuries

In the School SettingChanging the Culture to The Emergency Room

Steven P Fries MSPA-CDirector of Ortho Ouch CareComprehensive Orthopaedics

Wallingford CTOUCHCTCOM

This stacked bar chart has six bars by the following age groups

under 15 years 15 through 24 years 25 through 44 years 45 through 64 years 65 through 74 years and 75 years and over

Each showing the percent distribution of injury hospital discharge rates for fractures by body region categorized as head and neck spine and back torso upper extremities hip and other lower extremities

This bar chart has three sets of bars for three leading mechanisms of injury which are falls struck by or against and motor vehicle traffic Each set shows the percent distribution of initial emergency department injury visits by nature of injury grouped into the following five categories fractures contusions and superficial injuries sprains and strains open wounds and other injuries for the combined years 2004 and 2005

Four pie charts for data year 2004 show injury as a proportion of deaths hospital discharges initial emergency department visits and initial physician office and outpatient department visits

It also depicts the number 33 million of episodes of medically attended injuries reported in a national household survey

This line chart graphs

injury rates by single year of age for initial emergency department visits and hospital discharges for years 2003 through 2005 and death rates for the combined years 2003 and 2004

This pie chart shows the percent distribution of injuries by body region of injury for initial emergency department visits Body regions include head and neck spine and back torso upper and lower extremities system wide and other and unspecified

This pie chart shows the percent distribution of injuries by the leading mechanisms of initial injury emergency department visits including falls struck by or against motor vehicle traffic accidents cut or pierce all other mechanisms and those initial injury visits for which no mechanism was stated

Activities include leisure sports and exercise working around house or yard working at paid job driving or riding in a motor vehicle

Attending school and other

This bar chart has four sets of bars for initial emergency department injury visit rates for the four leading mechanisms of injury

which are fall struck by or against motor vehicle traffic and cut or pierce

Each set of bars shows the age-specific rates for under 15 years

15 through 24 years 25 through 44 years 45 through 64 years 65 through 74 years and 75 years and

over for the combined years 2004 and 2005

Initial ER VisitThis bar chart has four sets of bars for initial injury visit rates for the four leading mechanisms of injury Fall Struck by or against MVA Cut or Puncture

Each set of bars shows the age-specific rates for under 15 years 15 through 24 years 25 through 44 years 45 through 64 years 65 through 74 years and 75 years and

Injuries requiring medical attention or resulting in restricted activity affect approximately 20 million children and adolescents (2501000 persons) and cost of $17 billion annually in medical costs

Approximately 74 million adolescents aged 15--24 years sustain injuries requiring ER visits annually (2101 per 1000 persons)

Injuries requiring medical attention or resulting in restricted activity affect approximately 20 million children and adolescents (2501000 persons)

Cost of

$17 Billion Annually in

Medical costs

bull One study reported that 80 of elementary school children visited the school nurse for an injury-related

complaint bullInjury rate ~ 10--25 of children occur on school

premises bull Approximately 4 million kids are injured at school year

However the majority of school injuries are minor

Serious injuries are more likely to occur at home or in the community

(EMS) dispatches to schools represent 6of all EMS incidents for school-aged children

Fatalities at school are rare approximately 1 in 400 injury-related fatalities in children aged 5--19 years

occur at school

Injuries at school are most likely to occur on playgrounds (particularly on climbing equipment) on athletic fields and in gymnasiums

The majority of injuries at school are unintentional not violent

The most frequent causes of school-associated injuries resulting in ER visits

bull Falls (43)

bullSports activities (34)

bullAssaults 10

bull Shop class account for 7

bull In 31 of states and 90 of districts schools are required to write an injury report when a student is seriously injured on school property

bull Among the states that require injury reports only two require districts or schools to submit injury report data to the state education agency or state health department

bullMale are injured 15 times more femalesbull Males are 3 times more to ERbull Middle and high school students sustain more injuries at than elementary school bullStudentsbull 41 are aged 15--19 yearsbull 31 are aged 11--14 years bull28 are aged 5--10 years

Sports-Related Injuries 8 million high school students participate in school- or community-sponsored sports annually

Approximately one million serious (ie injuries resulting in hospitalization surgical treatment missed school or one half day or more in bed) sports-related injuries occur annually to adolescents aged 10--17 years accounting for one third of all serious injuries in this age group

Develop Systematic Approach to the Evaluation and Management of Injuries

bullPrevention of further in jurybullMinimizes problemsComplicationsbullPractice make PerfectbullCall for helpbullImprovisebullReflect and reassess

Do the same thing every time

PRICEbullPROCTECTIONbullRESTbullICEbullCOMPRESSIONbullELEVATION

In 1997 sprains and strains were the injury conditions most frequently reported followed by open wounds fractures and contusions

Information on the site of the injury is now available and shows that injuries to the upper and lower extremities were most common

Current Trends Playground-Related Injuries in Preschool-Aged Children -- United States 1983-1987

From 1983 to 1987 nearly 672 million emergency room visits in the United States were for product-related injuries among preschool children 1-4 years old

Approximately 305000 (45) of these injuries involved playground equipment

These playground equipment-related injuries occurred most frequently at home (383) in sports or recreation settings (294) or at school (89)

Of the 82108 injuries in preschool-aged children attending day care (coded as occurring at school) 27232 (332) were related to playground equipment

bullA higher proportion of playground- related injuries occurred in the spring than at other times of the year

bullMost preschool-aged children with injuries involving school playground equipment were 3 or 4 years old and male

bullForty percent of playground-related injuries were associated with climbing apparatus

bull Two thirds of injuries were to the head and neck

Lacerations (385) contusions or abrasions (268) fractures (168) strains or sprains (44) and concussions (17) were most commonly reported (Table 2)

Head and neck injuries were primarily lacerations (557) and contusions or abrasions (237)

Injury to the extremities and trunk included mostly fractures contusions or abrasions and strains or sprains (upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 of preschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Reported by Div of Injury Epidemiology and Control Center for Environmental Health and Injury Control CDC

Injury to the extremities and trunk included

Mostly fracturesContusions or abrasions and strains or sprains

(Upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 ofpreschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Each year in the United States an estimated one in six residents requires medical treatment for an injury and an estimated one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury

This report summarizes national data on fatal and nonfatal injuries in the United States for 2001 by age sex mechanism intent and type of injury and other selected characteristics Reporting Period January--December 2001

For nonfatal injuries the majority of injured persons were treated in hospital EDs for

bull Lacerations (258) bull Strainssprains (202) bull Contusionsabrasions (183) bull Headneck region (295) majority bull Extremities (479)

Overall 55 of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care

Management

Quick and Dirty AssessmentABCrsquoSC-SPINENeurologicDeformities -PulsesWhen to call for helpCall parentsWhatrsquos in the Bag

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

This stacked bar chart has six bars by the following age groups

under 15 years 15 through 24 years 25 through 44 years 45 through 64 years 65 through 74 years and 75 years and over

Each showing the percent distribution of injury hospital discharge rates for fractures by body region categorized as head and neck spine and back torso upper extremities hip and other lower extremities

This bar chart has three sets of bars for three leading mechanisms of injury which are falls struck by or against and motor vehicle traffic Each set shows the percent distribution of initial emergency department injury visits by nature of injury grouped into the following five categories fractures contusions and superficial injuries sprains and strains open wounds and other injuries for the combined years 2004 and 2005

Four pie charts for data year 2004 show injury as a proportion of deaths hospital discharges initial emergency department visits and initial physician office and outpatient department visits

It also depicts the number 33 million of episodes of medically attended injuries reported in a national household survey

This line chart graphs

injury rates by single year of age for initial emergency department visits and hospital discharges for years 2003 through 2005 and death rates for the combined years 2003 and 2004

This pie chart shows the percent distribution of injuries by body region of injury for initial emergency department visits Body regions include head and neck spine and back torso upper and lower extremities system wide and other and unspecified

This pie chart shows the percent distribution of injuries by the leading mechanisms of initial injury emergency department visits including falls struck by or against motor vehicle traffic accidents cut or pierce all other mechanisms and those initial injury visits for which no mechanism was stated

Activities include leisure sports and exercise working around house or yard working at paid job driving or riding in a motor vehicle

Attending school and other

This bar chart has four sets of bars for initial emergency department injury visit rates for the four leading mechanisms of injury

which are fall struck by or against motor vehicle traffic and cut or pierce

Each set of bars shows the age-specific rates for under 15 years

15 through 24 years 25 through 44 years 45 through 64 years 65 through 74 years and 75 years and

over for the combined years 2004 and 2005

Initial ER VisitThis bar chart has four sets of bars for initial injury visit rates for the four leading mechanisms of injury Fall Struck by or against MVA Cut or Puncture

Each set of bars shows the age-specific rates for under 15 years 15 through 24 years 25 through 44 years 45 through 64 years 65 through 74 years and 75 years and

Injuries requiring medical attention or resulting in restricted activity affect approximately 20 million children and adolescents (2501000 persons) and cost of $17 billion annually in medical costs

Approximately 74 million adolescents aged 15--24 years sustain injuries requiring ER visits annually (2101 per 1000 persons)

Injuries requiring medical attention or resulting in restricted activity affect approximately 20 million children and adolescents (2501000 persons)

Cost of

$17 Billion Annually in

Medical costs

bull One study reported that 80 of elementary school children visited the school nurse for an injury-related

complaint bullInjury rate ~ 10--25 of children occur on school

premises bull Approximately 4 million kids are injured at school year

However the majority of school injuries are minor

Serious injuries are more likely to occur at home or in the community

(EMS) dispatches to schools represent 6of all EMS incidents for school-aged children

Fatalities at school are rare approximately 1 in 400 injury-related fatalities in children aged 5--19 years

occur at school

Injuries at school are most likely to occur on playgrounds (particularly on climbing equipment) on athletic fields and in gymnasiums

The majority of injuries at school are unintentional not violent

The most frequent causes of school-associated injuries resulting in ER visits

bull Falls (43)

bullSports activities (34)

bullAssaults 10

bull Shop class account for 7

bull In 31 of states and 90 of districts schools are required to write an injury report when a student is seriously injured on school property

bull Among the states that require injury reports only two require districts or schools to submit injury report data to the state education agency or state health department

bullMale are injured 15 times more femalesbull Males are 3 times more to ERbull Middle and high school students sustain more injuries at than elementary school bullStudentsbull 41 are aged 15--19 yearsbull 31 are aged 11--14 years bull28 are aged 5--10 years

Sports-Related Injuries 8 million high school students participate in school- or community-sponsored sports annually

Approximately one million serious (ie injuries resulting in hospitalization surgical treatment missed school or one half day or more in bed) sports-related injuries occur annually to adolescents aged 10--17 years accounting for one third of all serious injuries in this age group

Develop Systematic Approach to the Evaluation and Management of Injuries

bullPrevention of further in jurybullMinimizes problemsComplicationsbullPractice make PerfectbullCall for helpbullImprovisebullReflect and reassess

Do the same thing every time

PRICEbullPROCTECTIONbullRESTbullICEbullCOMPRESSIONbullELEVATION

In 1997 sprains and strains were the injury conditions most frequently reported followed by open wounds fractures and contusions

Information on the site of the injury is now available and shows that injuries to the upper and lower extremities were most common

Current Trends Playground-Related Injuries in Preschool-Aged Children -- United States 1983-1987

From 1983 to 1987 nearly 672 million emergency room visits in the United States were for product-related injuries among preschool children 1-4 years old

Approximately 305000 (45) of these injuries involved playground equipment

These playground equipment-related injuries occurred most frequently at home (383) in sports or recreation settings (294) or at school (89)

Of the 82108 injuries in preschool-aged children attending day care (coded as occurring at school) 27232 (332) were related to playground equipment

bullA higher proportion of playground- related injuries occurred in the spring than at other times of the year

bullMost preschool-aged children with injuries involving school playground equipment were 3 or 4 years old and male

bullForty percent of playground-related injuries were associated with climbing apparatus

bull Two thirds of injuries were to the head and neck

Lacerations (385) contusions or abrasions (268) fractures (168) strains or sprains (44) and concussions (17) were most commonly reported (Table 2)

Head and neck injuries were primarily lacerations (557) and contusions or abrasions (237)

Injury to the extremities and trunk included mostly fractures contusions or abrasions and strains or sprains (upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 of preschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Reported by Div of Injury Epidemiology and Control Center for Environmental Health and Injury Control CDC

Injury to the extremities and trunk included

Mostly fracturesContusions or abrasions and strains or sprains

(Upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 ofpreschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Each year in the United States an estimated one in six residents requires medical treatment for an injury and an estimated one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury

This report summarizes national data on fatal and nonfatal injuries in the United States for 2001 by age sex mechanism intent and type of injury and other selected characteristics Reporting Period January--December 2001

For nonfatal injuries the majority of injured persons were treated in hospital EDs for

bull Lacerations (258) bull Strainssprains (202) bull Contusionsabrasions (183) bull Headneck region (295) majority bull Extremities (479)

Overall 55 of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care

Management

Quick and Dirty AssessmentABCrsquoSC-SPINENeurologicDeformities -PulsesWhen to call for helpCall parentsWhatrsquos in the Bag

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

This bar chart has three sets of bars for three leading mechanisms of injury which are falls struck by or against and motor vehicle traffic Each set shows the percent distribution of initial emergency department injury visits by nature of injury grouped into the following five categories fractures contusions and superficial injuries sprains and strains open wounds and other injuries for the combined years 2004 and 2005

Four pie charts for data year 2004 show injury as a proportion of deaths hospital discharges initial emergency department visits and initial physician office and outpatient department visits

It also depicts the number 33 million of episodes of medically attended injuries reported in a national household survey

This line chart graphs

injury rates by single year of age for initial emergency department visits and hospital discharges for years 2003 through 2005 and death rates for the combined years 2003 and 2004

This pie chart shows the percent distribution of injuries by body region of injury for initial emergency department visits Body regions include head and neck spine and back torso upper and lower extremities system wide and other and unspecified

This pie chart shows the percent distribution of injuries by the leading mechanisms of initial injury emergency department visits including falls struck by or against motor vehicle traffic accidents cut or pierce all other mechanisms and those initial injury visits for which no mechanism was stated

Activities include leisure sports and exercise working around house or yard working at paid job driving or riding in a motor vehicle

Attending school and other

This bar chart has four sets of bars for initial emergency department injury visit rates for the four leading mechanisms of injury

which are fall struck by or against motor vehicle traffic and cut or pierce

Each set of bars shows the age-specific rates for under 15 years

15 through 24 years 25 through 44 years 45 through 64 years 65 through 74 years and 75 years and

over for the combined years 2004 and 2005

Initial ER VisitThis bar chart has four sets of bars for initial injury visit rates for the four leading mechanisms of injury Fall Struck by or against MVA Cut or Puncture

Each set of bars shows the age-specific rates for under 15 years 15 through 24 years 25 through 44 years 45 through 64 years 65 through 74 years and 75 years and

Injuries requiring medical attention or resulting in restricted activity affect approximately 20 million children and adolescents (2501000 persons) and cost of $17 billion annually in medical costs

Approximately 74 million adolescents aged 15--24 years sustain injuries requiring ER visits annually (2101 per 1000 persons)

Injuries requiring medical attention or resulting in restricted activity affect approximately 20 million children and adolescents (2501000 persons)

Cost of

$17 Billion Annually in

Medical costs

bull One study reported that 80 of elementary school children visited the school nurse for an injury-related

complaint bullInjury rate ~ 10--25 of children occur on school

premises bull Approximately 4 million kids are injured at school year

However the majority of school injuries are minor

Serious injuries are more likely to occur at home or in the community

(EMS) dispatches to schools represent 6of all EMS incidents for school-aged children

Fatalities at school are rare approximately 1 in 400 injury-related fatalities in children aged 5--19 years

occur at school

Injuries at school are most likely to occur on playgrounds (particularly on climbing equipment) on athletic fields and in gymnasiums

The majority of injuries at school are unintentional not violent

The most frequent causes of school-associated injuries resulting in ER visits

bull Falls (43)

bullSports activities (34)

bullAssaults 10

bull Shop class account for 7

bull In 31 of states and 90 of districts schools are required to write an injury report when a student is seriously injured on school property

bull Among the states that require injury reports only two require districts or schools to submit injury report data to the state education agency or state health department

bullMale are injured 15 times more femalesbull Males are 3 times more to ERbull Middle and high school students sustain more injuries at than elementary school bullStudentsbull 41 are aged 15--19 yearsbull 31 are aged 11--14 years bull28 are aged 5--10 years

Sports-Related Injuries 8 million high school students participate in school- or community-sponsored sports annually

Approximately one million serious (ie injuries resulting in hospitalization surgical treatment missed school or one half day or more in bed) sports-related injuries occur annually to adolescents aged 10--17 years accounting for one third of all serious injuries in this age group

Develop Systematic Approach to the Evaluation and Management of Injuries

bullPrevention of further in jurybullMinimizes problemsComplicationsbullPractice make PerfectbullCall for helpbullImprovisebullReflect and reassess

Do the same thing every time

PRICEbullPROCTECTIONbullRESTbullICEbullCOMPRESSIONbullELEVATION

In 1997 sprains and strains were the injury conditions most frequently reported followed by open wounds fractures and contusions

Information on the site of the injury is now available and shows that injuries to the upper and lower extremities were most common

Current Trends Playground-Related Injuries in Preschool-Aged Children -- United States 1983-1987

From 1983 to 1987 nearly 672 million emergency room visits in the United States were for product-related injuries among preschool children 1-4 years old

Approximately 305000 (45) of these injuries involved playground equipment

These playground equipment-related injuries occurred most frequently at home (383) in sports or recreation settings (294) or at school (89)

Of the 82108 injuries in preschool-aged children attending day care (coded as occurring at school) 27232 (332) were related to playground equipment

bullA higher proportion of playground- related injuries occurred in the spring than at other times of the year

bullMost preschool-aged children with injuries involving school playground equipment were 3 or 4 years old and male

bullForty percent of playground-related injuries were associated with climbing apparatus

bull Two thirds of injuries were to the head and neck

Lacerations (385) contusions or abrasions (268) fractures (168) strains or sprains (44) and concussions (17) were most commonly reported (Table 2)

Head and neck injuries were primarily lacerations (557) and contusions or abrasions (237)

Injury to the extremities and trunk included mostly fractures contusions or abrasions and strains or sprains (upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 of preschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Reported by Div of Injury Epidemiology and Control Center for Environmental Health and Injury Control CDC

Injury to the extremities and trunk included

Mostly fracturesContusions or abrasions and strains or sprains

(Upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 ofpreschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Each year in the United States an estimated one in six residents requires medical treatment for an injury and an estimated one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury

This report summarizes national data on fatal and nonfatal injuries in the United States for 2001 by age sex mechanism intent and type of injury and other selected characteristics Reporting Period January--December 2001

For nonfatal injuries the majority of injured persons were treated in hospital EDs for

bull Lacerations (258) bull Strainssprains (202) bull Contusionsabrasions (183) bull Headneck region (295) majority bull Extremities (479)

Overall 55 of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care

Management

Quick and Dirty AssessmentABCrsquoSC-SPINENeurologicDeformities -PulsesWhen to call for helpCall parentsWhatrsquos in the Bag

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

Four pie charts for data year 2004 show injury as a proportion of deaths hospital discharges initial emergency department visits and initial physician office and outpatient department visits

It also depicts the number 33 million of episodes of medically attended injuries reported in a national household survey

This line chart graphs

injury rates by single year of age for initial emergency department visits and hospital discharges for years 2003 through 2005 and death rates for the combined years 2003 and 2004

This pie chart shows the percent distribution of injuries by body region of injury for initial emergency department visits Body regions include head and neck spine and back torso upper and lower extremities system wide and other and unspecified

This pie chart shows the percent distribution of injuries by the leading mechanisms of initial injury emergency department visits including falls struck by or against motor vehicle traffic accidents cut or pierce all other mechanisms and those initial injury visits for which no mechanism was stated

Activities include leisure sports and exercise working around house or yard working at paid job driving or riding in a motor vehicle

Attending school and other

This bar chart has four sets of bars for initial emergency department injury visit rates for the four leading mechanisms of injury

which are fall struck by or against motor vehicle traffic and cut or pierce

Each set of bars shows the age-specific rates for under 15 years

15 through 24 years 25 through 44 years 45 through 64 years 65 through 74 years and 75 years and

over for the combined years 2004 and 2005

Initial ER VisitThis bar chart has four sets of bars for initial injury visit rates for the four leading mechanisms of injury Fall Struck by or against MVA Cut or Puncture

Each set of bars shows the age-specific rates for under 15 years 15 through 24 years 25 through 44 years 45 through 64 years 65 through 74 years and 75 years and

Injuries requiring medical attention or resulting in restricted activity affect approximately 20 million children and adolescents (2501000 persons) and cost of $17 billion annually in medical costs

Approximately 74 million adolescents aged 15--24 years sustain injuries requiring ER visits annually (2101 per 1000 persons)

Injuries requiring medical attention or resulting in restricted activity affect approximately 20 million children and adolescents (2501000 persons)

Cost of

$17 Billion Annually in

Medical costs

bull One study reported that 80 of elementary school children visited the school nurse for an injury-related

complaint bullInjury rate ~ 10--25 of children occur on school

premises bull Approximately 4 million kids are injured at school year

However the majority of school injuries are minor

Serious injuries are more likely to occur at home or in the community

(EMS) dispatches to schools represent 6of all EMS incidents for school-aged children

Fatalities at school are rare approximately 1 in 400 injury-related fatalities in children aged 5--19 years

occur at school

Injuries at school are most likely to occur on playgrounds (particularly on climbing equipment) on athletic fields and in gymnasiums

The majority of injuries at school are unintentional not violent

The most frequent causes of school-associated injuries resulting in ER visits

bull Falls (43)

bullSports activities (34)

bullAssaults 10

bull Shop class account for 7

bull In 31 of states and 90 of districts schools are required to write an injury report when a student is seriously injured on school property

bull Among the states that require injury reports only two require districts or schools to submit injury report data to the state education agency or state health department

bullMale are injured 15 times more femalesbull Males are 3 times more to ERbull Middle and high school students sustain more injuries at than elementary school bullStudentsbull 41 are aged 15--19 yearsbull 31 are aged 11--14 years bull28 are aged 5--10 years

Sports-Related Injuries 8 million high school students participate in school- or community-sponsored sports annually

Approximately one million serious (ie injuries resulting in hospitalization surgical treatment missed school or one half day or more in bed) sports-related injuries occur annually to adolescents aged 10--17 years accounting for one third of all serious injuries in this age group

Develop Systematic Approach to the Evaluation and Management of Injuries

bullPrevention of further in jurybullMinimizes problemsComplicationsbullPractice make PerfectbullCall for helpbullImprovisebullReflect and reassess

Do the same thing every time

PRICEbullPROCTECTIONbullRESTbullICEbullCOMPRESSIONbullELEVATION

In 1997 sprains and strains were the injury conditions most frequently reported followed by open wounds fractures and contusions

Information on the site of the injury is now available and shows that injuries to the upper and lower extremities were most common

Current Trends Playground-Related Injuries in Preschool-Aged Children -- United States 1983-1987

From 1983 to 1987 nearly 672 million emergency room visits in the United States were for product-related injuries among preschool children 1-4 years old

Approximately 305000 (45) of these injuries involved playground equipment

These playground equipment-related injuries occurred most frequently at home (383) in sports or recreation settings (294) or at school (89)

Of the 82108 injuries in preschool-aged children attending day care (coded as occurring at school) 27232 (332) were related to playground equipment

bullA higher proportion of playground- related injuries occurred in the spring than at other times of the year

bullMost preschool-aged children with injuries involving school playground equipment were 3 or 4 years old and male

bullForty percent of playground-related injuries were associated with climbing apparatus

bull Two thirds of injuries were to the head and neck

Lacerations (385) contusions or abrasions (268) fractures (168) strains or sprains (44) and concussions (17) were most commonly reported (Table 2)

Head and neck injuries were primarily lacerations (557) and contusions or abrasions (237)

Injury to the extremities and trunk included mostly fractures contusions or abrasions and strains or sprains (upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 of preschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Reported by Div of Injury Epidemiology and Control Center for Environmental Health and Injury Control CDC

Injury to the extremities and trunk included

Mostly fracturesContusions or abrasions and strains or sprains

(Upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 ofpreschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Each year in the United States an estimated one in six residents requires medical treatment for an injury and an estimated one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury

This report summarizes national data on fatal and nonfatal injuries in the United States for 2001 by age sex mechanism intent and type of injury and other selected characteristics Reporting Period January--December 2001

For nonfatal injuries the majority of injured persons were treated in hospital EDs for

bull Lacerations (258) bull Strainssprains (202) bull Contusionsabrasions (183) bull Headneck region (295) majority bull Extremities (479)

Overall 55 of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care

Management

Quick and Dirty AssessmentABCrsquoSC-SPINENeurologicDeformities -PulsesWhen to call for helpCall parentsWhatrsquos in the Bag

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

This line chart graphs

injury rates by single year of age for initial emergency department visits and hospital discharges for years 2003 through 2005 and death rates for the combined years 2003 and 2004

This pie chart shows the percent distribution of injuries by body region of injury for initial emergency department visits Body regions include head and neck spine and back torso upper and lower extremities system wide and other and unspecified

This pie chart shows the percent distribution of injuries by the leading mechanisms of initial injury emergency department visits including falls struck by or against motor vehicle traffic accidents cut or pierce all other mechanisms and those initial injury visits for which no mechanism was stated

Activities include leisure sports and exercise working around house or yard working at paid job driving or riding in a motor vehicle

Attending school and other

This bar chart has four sets of bars for initial emergency department injury visit rates for the four leading mechanisms of injury

which are fall struck by or against motor vehicle traffic and cut or pierce

Each set of bars shows the age-specific rates for under 15 years

15 through 24 years 25 through 44 years 45 through 64 years 65 through 74 years and 75 years and

over for the combined years 2004 and 2005

Initial ER VisitThis bar chart has four sets of bars for initial injury visit rates for the four leading mechanisms of injury Fall Struck by or against MVA Cut or Puncture

Each set of bars shows the age-specific rates for under 15 years 15 through 24 years 25 through 44 years 45 through 64 years 65 through 74 years and 75 years and

Injuries requiring medical attention or resulting in restricted activity affect approximately 20 million children and adolescents (2501000 persons) and cost of $17 billion annually in medical costs

Approximately 74 million adolescents aged 15--24 years sustain injuries requiring ER visits annually (2101 per 1000 persons)

Injuries requiring medical attention or resulting in restricted activity affect approximately 20 million children and adolescents (2501000 persons)

Cost of

$17 Billion Annually in

Medical costs

bull One study reported that 80 of elementary school children visited the school nurse for an injury-related

complaint bullInjury rate ~ 10--25 of children occur on school

premises bull Approximately 4 million kids are injured at school year

However the majority of school injuries are minor

Serious injuries are more likely to occur at home or in the community

(EMS) dispatches to schools represent 6of all EMS incidents for school-aged children

Fatalities at school are rare approximately 1 in 400 injury-related fatalities in children aged 5--19 years

occur at school

Injuries at school are most likely to occur on playgrounds (particularly on climbing equipment) on athletic fields and in gymnasiums

The majority of injuries at school are unintentional not violent

The most frequent causes of school-associated injuries resulting in ER visits

bull Falls (43)

bullSports activities (34)

bullAssaults 10

bull Shop class account for 7

bull In 31 of states and 90 of districts schools are required to write an injury report when a student is seriously injured on school property

bull Among the states that require injury reports only two require districts or schools to submit injury report data to the state education agency or state health department

bullMale are injured 15 times more femalesbull Males are 3 times more to ERbull Middle and high school students sustain more injuries at than elementary school bullStudentsbull 41 are aged 15--19 yearsbull 31 are aged 11--14 years bull28 are aged 5--10 years

Sports-Related Injuries 8 million high school students participate in school- or community-sponsored sports annually

Approximately one million serious (ie injuries resulting in hospitalization surgical treatment missed school or one half day or more in bed) sports-related injuries occur annually to adolescents aged 10--17 years accounting for one third of all serious injuries in this age group

Develop Systematic Approach to the Evaluation and Management of Injuries

bullPrevention of further in jurybullMinimizes problemsComplicationsbullPractice make PerfectbullCall for helpbullImprovisebullReflect and reassess

Do the same thing every time

PRICEbullPROCTECTIONbullRESTbullICEbullCOMPRESSIONbullELEVATION

In 1997 sprains and strains were the injury conditions most frequently reported followed by open wounds fractures and contusions

Information on the site of the injury is now available and shows that injuries to the upper and lower extremities were most common

Current Trends Playground-Related Injuries in Preschool-Aged Children -- United States 1983-1987

From 1983 to 1987 nearly 672 million emergency room visits in the United States were for product-related injuries among preschool children 1-4 years old

Approximately 305000 (45) of these injuries involved playground equipment

These playground equipment-related injuries occurred most frequently at home (383) in sports or recreation settings (294) or at school (89)

Of the 82108 injuries in preschool-aged children attending day care (coded as occurring at school) 27232 (332) were related to playground equipment

bullA higher proportion of playground- related injuries occurred in the spring than at other times of the year

bullMost preschool-aged children with injuries involving school playground equipment were 3 or 4 years old and male

bullForty percent of playground-related injuries were associated with climbing apparatus

bull Two thirds of injuries were to the head and neck

Lacerations (385) contusions or abrasions (268) fractures (168) strains or sprains (44) and concussions (17) were most commonly reported (Table 2)

Head and neck injuries were primarily lacerations (557) and contusions or abrasions (237)

Injury to the extremities and trunk included mostly fractures contusions or abrasions and strains or sprains (upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 of preschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Reported by Div of Injury Epidemiology and Control Center for Environmental Health and Injury Control CDC

Injury to the extremities and trunk included

Mostly fracturesContusions or abrasions and strains or sprains

(Upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 ofpreschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Each year in the United States an estimated one in six residents requires medical treatment for an injury and an estimated one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury

This report summarizes national data on fatal and nonfatal injuries in the United States for 2001 by age sex mechanism intent and type of injury and other selected characteristics Reporting Period January--December 2001

For nonfatal injuries the majority of injured persons were treated in hospital EDs for

bull Lacerations (258) bull Strainssprains (202) bull Contusionsabrasions (183) bull Headneck region (295) majority bull Extremities (479)

Overall 55 of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care

Management

Quick and Dirty AssessmentABCrsquoSC-SPINENeurologicDeformities -PulsesWhen to call for helpCall parentsWhatrsquos in the Bag

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

This pie chart shows the percent distribution of injuries by body region of injury for initial emergency department visits Body regions include head and neck spine and back torso upper and lower extremities system wide and other and unspecified

This pie chart shows the percent distribution of injuries by the leading mechanisms of initial injury emergency department visits including falls struck by or against motor vehicle traffic accidents cut or pierce all other mechanisms and those initial injury visits for which no mechanism was stated

Activities include leisure sports and exercise working around house or yard working at paid job driving or riding in a motor vehicle

Attending school and other

This bar chart has four sets of bars for initial emergency department injury visit rates for the four leading mechanisms of injury

which are fall struck by or against motor vehicle traffic and cut or pierce

Each set of bars shows the age-specific rates for under 15 years

15 through 24 years 25 through 44 years 45 through 64 years 65 through 74 years and 75 years and

over for the combined years 2004 and 2005

Initial ER VisitThis bar chart has four sets of bars for initial injury visit rates for the four leading mechanisms of injury Fall Struck by or against MVA Cut or Puncture

Each set of bars shows the age-specific rates for under 15 years 15 through 24 years 25 through 44 years 45 through 64 years 65 through 74 years and 75 years and

Injuries requiring medical attention or resulting in restricted activity affect approximately 20 million children and adolescents (2501000 persons) and cost of $17 billion annually in medical costs

Approximately 74 million adolescents aged 15--24 years sustain injuries requiring ER visits annually (2101 per 1000 persons)

Injuries requiring medical attention or resulting in restricted activity affect approximately 20 million children and adolescents (2501000 persons)

Cost of

$17 Billion Annually in

Medical costs

bull One study reported that 80 of elementary school children visited the school nurse for an injury-related

complaint bullInjury rate ~ 10--25 of children occur on school

premises bull Approximately 4 million kids are injured at school year

However the majority of school injuries are minor

Serious injuries are more likely to occur at home or in the community

(EMS) dispatches to schools represent 6of all EMS incidents for school-aged children

Fatalities at school are rare approximately 1 in 400 injury-related fatalities in children aged 5--19 years

occur at school

Injuries at school are most likely to occur on playgrounds (particularly on climbing equipment) on athletic fields and in gymnasiums

The majority of injuries at school are unintentional not violent

The most frequent causes of school-associated injuries resulting in ER visits

bull Falls (43)

bullSports activities (34)

bullAssaults 10

bull Shop class account for 7

bull In 31 of states and 90 of districts schools are required to write an injury report when a student is seriously injured on school property

bull Among the states that require injury reports only two require districts or schools to submit injury report data to the state education agency or state health department

bullMale are injured 15 times more femalesbull Males are 3 times more to ERbull Middle and high school students sustain more injuries at than elementary school bullStudentsbull 41 are aged 15--19 yearsbull 31 are aged 11--14 years bull28 are aged 5--10 years

Sports-Related Injuries 8 million high school students participate in school- or community-sponsored sports annually

Approximately one million serious (ie injuries resulting in hospitalization surgical treatment missed school or one half day or more in bed) sports-related injuries occur annually to adolescents aged 10--17 years accounting for one third of all serious injuries in this age group

Develop Systematic Approach to the Evaluation and Management of Injuries

bullPrevention of further in jurybullMinimizes problemsComplicationsbullPractice make PerfectbullCall for helpbullImprovisebullReflect and reassess

Do the same thing every time

PRICEbullPROCTECTIONbullRESTbullICEbullCOMPRESSIONbullELEVATION

In 1997 sprains and strains were the injury conditions most frequently reported followed by open wounds fractures and contusions

Information on the site of the injury is now available and shows that injuries to the upper and lower extremities were most common

Current Trends Playground-Related Injuries in Preschool-Aged Children -- United States 1983-1987

From 1983 to 1987 nearly 672 million emergency room visits in the United States were for product-related injuries among preschool children 1-4 years old

Approximately 305000 (45) of these injuries involved playground equipment

These playground equipment-related injuries occurred most frequently at home (383) in sports or recreation settings (294) or at school (89)

Of the 82108 injuries in preschool-aged children attending day care (coded as occurring at school) 27232 (332) were related to playground equipment

bullA higher proportion of playground- related injuries occurred in the spring than at other times of the year

bullMost preschool-aged children with injuries involving school playground equipment were 3 or 4 years old and male

bullForty percent of playground-related injuries were associated with climbing apparatus

bull Two thirds of injuries were to the head and neck

Lacerations (385) contusions or abrasions (268) fractures (168) strains or sprains (44) and concussions (17) were most commonly reported (Table 2)

Head and neck injuries were primarily lacerations (557) and contusions or abrasions (237)

Injury to the extremities and trunk included mostly fractures contusions or abrasions and strains or sprains (upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 of preschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Reported by Div of Injury Epidemiology and Control Center for Environmental Health and Injury Control CDC

Injury to the extremities and trunk included

Mostly fracturesContusions or abrasions and strains or sprains

(Upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 ofpreschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Each year in the United States an estimated one in six residents requires medical treatment for an injury and an estimated one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury

This report summarizes national data on fatal and nonfatal injuries in the United States for 2001 by age sex mechanism intent and type of injury and other selected characteristics Reporting Period January--December 2001

For nonfatal injuries the majority of injured persons were treated in hospital EDs for

bull Lacerations (258) bull Strainssprains (202) bull Contusionsabrasions (183) bull Headneck region (295) majority bull Extremities (479)

Overall 55 of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care

Management

Quick and Dirty AssessmentABCrsquoSC-SPINENeurologicDeformities -PulsesWhen to call for helpCall parentsWhatrsquos in the Bag

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

This pie chart shows the percent distribution of injuries by the leading mechanisms of initial injury emergency department visits including falls struck by or against motor vehicle traffic accidents cut or pierce all other mechanisms and those initial injury visits for which no mechanism was stated

Activities include leisure sports and exercise working around house or yard working at paid job driving or riding in a motor vehicle

Attending school and other

This bar chart has four sets of bars for initial emergency department injury visit rates for the four leading mechanisms of injury

which are fall struck by or against motor vehicle traffic and cut or pierce

Each set of bars shows the age-specific rates for under 15 years

15 through 24 years 25 through 44 years 45 through 64 years 65 through 74 years and 75 years and

over for the combined years 2004 and 2005

Initial ER VisitThis bar chart has four sets of bars for initial injury visit rates for the four leading mechanisms of injury Fall Struck by or against MVA Cut or Puncture

Each set of bars shows the age-specific rates for under 15 years 15 through 24 years 25 through 44 years 45 through 64 years 65 through 74 years and 75 years and

Injuries requiring medical attention or resulting in restricted activity affect approximately 20 million children and adolescents (2501000 persons) and cost of $17 billion annually in medical costs

Approximately 74 million adolescents aged 15--24 years sustain injuries requiring ER visits annually (2101 per 1000 persons)

Injuries requiring medical attention or resulting in restricted activity affect approximately 20 million children and adolescents (2501000 persons)

Cost of

$17 Billion Annually in

Medical costs

bull One study reported that 80 of elementary school children visited the school nurse for an injury-related

complaint bullInjury rate ~ 10--25 of children occur on school

premises bull Approximately 4 million kids are injured at school year

However the majority of school injuries are minor

Serious injuries are more likely to occur at home or in the community

(EMS) dispatches to schools represent 6of all EMS incidents for school-aged children

Fatalities at school are rare approximately 1 in 400 injury-related fatalities in children aged 5--19 years

occur at school

Injuries at school are most likely to occur on playgrounds (particularly on climbing equipment) on athletic fields and in gymnasiums

The majority of injuries at school are unintentional not violent

The most frequent causes of school-associated injuries resulting in ER visits

bull Falls (43)

bullSports activities (34)

bullAssaults 10

bull Shop class account for 7

bull In 31 of states and 90 of districts schools are required to write an injury report when a student is seriously injured on school property

bull Among the states that require injury reports only two require districts or schools to submit injury report data to the state education agency or state health department

bullMale are injured 15 times more femalesbull Males are 3 times more to ERbull Middle and high school students sustain more injuries at than elementary school bullStudentsbull 41 are aged 15--19 yearsbull 31 are aged 11--14 years bull28 are aged 5--10 years

Sports-Related Injuries 8 million high school students participate in school- or community-sponsored sports annually

Approximately one million serious (ie injuries resulting in hospitalization surgical treatment missed school or one half day or more in bed) sports-related injuries occur annually to adolescents aged 10--17 years accounting for one third of all serious injuries in this age group

Develop Systematic Approach to the Evaluation and Management of Injuries

bullPrevention of further in jurybullMinimizes problemsComplicationsbullPractice make PerfectbullCall for helpbullImprovisebullReflect and reassess

Do the same thing every time

PRICEbullPROCTECTIONbullRESTbullICEbullCOMPRESSIONbullELEVATION

In 1997 sprains and strains were the injury conditions most frequently reported followed by open wounds fractures and contusions

Information on the site of the injury is now available and shows that injuries to the upper and lower extremities were most common

Current Trends Playground-Related Injuries in Preschool-Aged Children -- United States 1983-1987

From 1983 to 1987 nearly 672 million emergency room visits in the United States were for product-related injuries among preschool children 1-4 years old

Approximately 305000 (45) of these injuries involved playground equipment

These playground equipment-related injuries occurred most frequently at home (383) in sports or recreation settings (294) or at school (89)

Of the 82108 injuries in preschool-aged children attending day care (coded as occurring at school) 27232 (332) were related to playground equipment

bullA higher proportion of playground- related injuries occurred in the spring than at other times of the year

bullMost preschool-aged children with injuries involving school playground equipment were 3 or 4 years old and male

bullForty percent of playground-related injuries were associated with climbing apparatus

bull Two thirds of injuries were to the head and neck

Lacerations (385) contusions or abrasions (268) fractures (168) strains or sprains (44) and concussions (17) were most commonly reported (Table 2)

Head and neck injuries were primarily lacerations (557) and contusions or abrasions (237)

Injury to the extremities and trunk included mostly fractures contusions or abrasions and strains or sprains (upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 of preschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Reported by Div of Injury Epidemiology and Control Center for Environmental Health and Injury Control CDC

Injury to the extremities and trunk included

Mostly fracturesContusions or abrasions and strains or sprains

(Upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 ofpreschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Each year in the United States an estimated one in six residents requires medical treatment for an injury and an estimated one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury

This report summarizes national data on fatal and nonfatal injuries in the United States for 2001 by age sex mechanism intent and type of injury and other selected characteristics Reporting Period January--December 2001

For nonfatal injuries the majority of injured persons were treated in hospital EDs for

bull Lacerations (258) bull Strainssprains (202) bull Contusionsabrasions (183) bull Headneck region (295) majority bull Extremities (479)

Overall 55 of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care

Management

Quick and Dirty AssessmentABCrsquoSC-SPINENeurologicDeformities -PulsesWhen to call for helpCall parentsWhatrsquos in the Bag

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

Activities include leisure sports and exercise working around house or yard working at paid job driving or riding in a motor vehicle

Attending school and other

This bar chart has four sets of bars for initial emergency department injury visit rates for the four leading mechanisms of injury

which are fall struck by or against motor vehicle traffic and cut or pierce

Each set of bars shows the age-specific rates for under 15 years

15 through 24 years 25 through 44 years 45 through 64 years 65 through 74 years and 75 years and

over for the combined years 2004 and 2005

Initial ER VisitThis bar chart has four sets of bars for initial injury visit rates for the four leading mechanisms of injury Fall Struck by or against MVA Cut or Puncture

Each set of bars shows the age-specific rates for under 15 years 15 through 24 years 25 through 44 years 45 through 64 years 65 through 74 years and 75 years and

Injuries requiring medical attention or resulting in restricted activity affect approximately 20 million children and adolescents (2501000 persons) and cost of $17 billion annually in medical costs

Approximately 74 million adolescents aged 15--24 years sustain injuries requiring ER visits annually (2101 per 1000 persons)

Injuries requiring medical attention or resulting in restricted activity affect approximately 20 million children and adolescents (2501000 persons)

Cost of

$17 Billion Annually in

Medical costs

bull One study reported that 80 of elementary school children visited the school nurse for an injury-related

complaint bullInjury rate ~ 10--25 of children occur on school

premises bull Approximately 4 million kids are injured at school year

However the majority of school injuries are minor

Serious injuries are more likely to occur at home or in the community

(EMS) dispatches to schools represent 6of all EMS incidents for school-aged children

Fatalities at school are rare approximately 1 in 400 injury-related fatalities in children aged 5--19 years

occur at school

Injuries at school are most likely to occur on playgrounds (particularly on climbing equipment) on athletic fields and in gymnasiums

The majority of injuries at school are unintentional not violent

The most frequent causes of school-associated injuries resulting in ER visits

bull Falls (43)

bullSports activities (34)

bullAssaults 10

bull Shop class account for 7

bull In 31 of states and 90 of districts schools are required to write an injury report when a student is seriously injured on school property

bull Among the states that require injury reports only two require districts or schools to submit injury report data to the state education agency or state health department

bullMale are injured 15 times more femalesbull Males are 3 times more to ERbull Middle and high school students sustain more injuries at than elementary school bullStudentsbull 41 are aged 15--19 yearsbull 31 are aged 11--14 years bull28 are aged 5--10 years

Sports-Related Injuries 8 million high school students participate in school- or community-sponsored sports annually

Approximately one million serious (ie injuries resulting in hospitalization surgical treatment missed school or one half day or more in bed) sports-related injuries occur annually to adolescents aged 10--17 years accounting for one third of all serious injuries in this age group

Develop Systematic Approach to the Evaluation and Management of Injuries

bullPrevention of further in jurybullMinimizes problemsComplicationsbullPractice make PerfectbullCall for helpbullImprovisebullReflect and reassess

Do the same thing every time

PRICEbullPROCTECTIONbullRESTbullICEbullCOMPRESSIONbullELEVATION

In 1997 sprains and strains were the injury conditions most frequently reported followed by open wounds fractures and contusions

Information on the site of the injury is now available and shows that injuries to the upper and lower extremities were most common

Current Trends Playground-Related Injuries in Preschool-Aged Children -- United States 1983-1987

From 1983 to 1987 nearly 672 million emergency room visits in the United States were for product-related injuries among preschool children 1-4 years old

Approximately 305000 (45) of these injuries involved playground equipment

These playground equipment-related injuries occurred most frequently at home (383) in sports or recreation settings (294) or at school (89)

Of the 82108 injuries in preschool-aged children attending day care (coded as occurring at school) 27232 (332) were related to playground equipment

bullA higher proportion of playground- related injuries occurred in the spring than at other times of the year

bullMost preschool-aged children with injuries involving school playground equipment were 3 or 4 years old and male

bullForty percent of playground-related injuries were associated with climbing apparatus

bull Two thirds of injuries were to the head and neck

Lacerations (385) contusions or abrasions (268) fractures (168) strains or sprains (44) and concussions (17) were most commonly reported (Table 2)

Head and neck injuries were primarily lacerations (557) and contusions or abrasions (237)

Injury to the extremities and trunk included mostly fractures contusions or abrasions and strains or sprains (upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 of preschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Reported by Div of Injury Epidemiology and Control Center for Environmental Health and Injury Control CDC

Injury to the extremities and trunk included

Mostly fracturesContusions or abrasions and strains or sprains

(Upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 ofpreschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Each year in the United States an estimated one in six residents requires medical treatment for an injury and an estimated one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury

This report summarizes national data on fatal and nonfatal injuries in the United States for 2001 by age sex mechanism intent and type of injury and other selected characteristics Reporting Period January--December 2001

For nonfatal injuries the majority of injured persons were treated in hospital EDs for

bull Lacerations (258) bull Strainssprains (202) bull Contusionsabrasions (183) bull Headneck region (295) majority bull Extremities (479)

Overall 55 of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care

Management

Quick and Dirty AssessmentABCrsquoSC-SPINENeurologicDeformities -PulsesWhen to call for helpCall parentsWhatrsquos in the Bag

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

This bar chart has four sets of bars for initial emergency department injury visit rates for the four leading mechanisms of injury

which are fall struck by or against motor vehicle traffic and cut or pierce

Each set of bars shows the age-specific rates for under 15 years

15 through 24 years 25 through 44 years 45 through 64 years 65 through 74 years and 75 years and

over for the combined years 2004 and 2005

Initial ER VisitThis bar chart has four sets of bars for initial injury visit rates for the four leading mechanisms of injury Fall Struck by or against MVA Cut or Puncture

Each set of bars shows the age-specific rates for under 15 years 15 through 24 years 25 through 44 years 45 through 64 years 65 through 74 years and 75 years and

Injuries requiring medical attention or resulting in restricted activity affect approximately 20 million children and adolescents (2501000 persons) and cost of $17 billion annually in medical costs

Approximately 74 million adolescents aged 15--24 years sustain injuries requiring ER visits annually (2101 per 1000 persons)

Injuries requiring medical attention or resulting in restricted activity affect approximately 20 million children and adolescents (2501000 persons)

Cost of

$17 Billion Annually in

Medical costs

bull One study reported that 80 of elementary school children visited the school nurse for an injury-related

complaint bullInjury rate ~ 10--25 of children occur on school

premises bull Approximately 4 million kids are injured at school year

However the majority of school injuries are minor

Serious injuries are more likely to occur at home or in the community

(EMS) dispatches to schools represent 6of all EMS incidents for school-aged children

Fatalities at school are rare approximately 1 in 400 injury-related fatalities in children aged 5--19 years

occur at school

Injuries at school are most likely to occur on playgrounds (particularly on climbing equipment) on athletic fields and in gymnasiums

The majority of injuries at school are unintentional not violent

The most frequent causes of school-associated injuries resulting in ER visits

bull Falls (43)

bullSports activities (34)

bullAssaults 10

bull Shop class account for 7

bull In 31 of states and 90 of districts schools are required to write an injury report when a student is seriously injured on school property

bull Among the states that require injury reports only two require districts or schools to submit injury report data to the state education agency or state health department

bullMale are injured 15 times more femalesbull Males are 3 times more to ERbull Middle and high school students sustain more injuries at than elementary school bullStudentsbull 41 are aged 15--19 yearsbull 31 are aged 11--14 years bull28 are aged 5--10 years

Sports-Related Injuries 8 million high school students participate in school- or community-sponsored sports annually

Approximately one million serious (ie injuries resulting in hospitalization surgical treatment missed school or one half day or more in bed) sports-related injuries occur annually to adolescents aged 10--17 years accounting for one third of all serious injuries in this age group

Develop Systematic Approach to the Evaluation and Management of Injuries

bullPrevention of further in jurybullMinimizes problemsComplicationsbullPractice make PerfectbullCall for helpbullImprovisebullReflect and reassess

Do the same thing every time

PRICEbullPROCTECTIONbullRESTbullICEbullCOMPRESSIONbullELEVATION

In 1997 sprains and strains were the injury conditions most frequently reported followed by open wounds fractures and contusions

Information on the site of the injury is now available and shows that injuries to the upper and lower extremities were most common

Current Trends Playground-Related Injuries in Preschool-Aged Children -- United States 1983-1987

From 1983 to 1987 nearly 672 million emergency room visits in the United States were for product-related injuries among preschool children 1-4 years old

Approximately 305000 (45) of these injuries involved playground equipment

These playground equipment-related injuries occurred most frequently at home (383) in sports or recreation settings (294) or at school (89)

Of the 82108 injuries in preschool-aged children attending day care (coded as occurring at school) 27232 (332) were related to playground equipment

bullA higher proportion of playground- related injuries occurred in the spring than at other times of the year

bullMost preschool-aged children with injuries involving school playground equipment were 3 or 4 years old and male

bullForty percent of playground-related injuries were associated with climbing apparatus

bull Two thirds of injuries were to the head and neck

Lacerations (385) contusions or abrasions (268) fractures (168) strains or sprains (44) and concussions (17) were most commonly reported (Table 2)

Head and neck injuries were primarily lacerations (557) and contusions or abrasions (237)

Injury to the extremities and trunk included mostly fractures contusions or abrasions and strains or sprains (upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 of preschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Reported by Div of Injury Epidemiology and Control Center for Environmental Health and Injury Control CDC

Injury to the extremities and trunk included

Mostly fracturesContusions or abrasions and strains or sprains

(Upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 ofpreschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Each year in the United States an estimated one in six residents requires medical treatment for an injury and an estimated one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury

This report summarizes national data on fatal and nonfatal injuries in the United States for 2001 by age sex mechanism intent and type of injury and other selected characteristics Reporting Period January--December 2001

For nonfatal injuries the majority of injured persons were treated in hospital EDs for

bull Lacerations (258) bull Strainssprains (202) bull Contusionsabrasions (183) bull Headneck region (295) majority bull Extremities (479)

Overall 55 of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care

Management

Quick and Dirty AssessmentABCrsquoSC-SPINENeurologicDeformities -PulsesWhen to call for helpCall parentsWhatrsquos in the Bag

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

Initial ER VisitThis bar chart has four sets of bars for initial injury visit rates for the four leading mechanisms of injury Fall Struck by or against MVA Cut or Puncture

Each set of bars shows the age-specific rates for under 15 years 15 through 24 years 25 through 44 years 45 through 64 years 65 through 74 years and 75 years and

Injuries requiring medical attention or resulting in restricted activity affect approximately 20 million children and adolescents (2501000 persons) and cost of $17 billion annually in medical costs

Approximately 74 million adolescents aged 15--24 years sustain injuries requiring ER visits annually (2101 per 1000 persons)

Injuries requiring medical attention or resulting in restricted activity affect approximately 20 million children and adolescents (2501000 persons)

Cost of

$17 Billion Annually in

Medical costs

bull One study reported that 80 of elementary school children visited the school nurse for an injury-related

complaint bullInjury rate ~ 10--25 of children occur on school

premises bull Approximately 4 million kids are injured at school year

However the majority of school injuries are minor

Serious injuries are more likely to occur at home or in the community

(EMS) dispatches to schools represent 6of all EMS incidents for school-aged children

Fatalities at school are rare approximately 1 in 400 injury-related fatalities in children aged 5--19 years

occur at school

Injuries at school are most likely to occur on playgrounds (particularly on climbing equipment) on athletic fields and in gymnasiums

The majority of injuries at school are unintentional not violent

The most frequent causes of school-associated injuries resulting in ER visits

bull Falls (43)

bullSports activities (34)

bullAssaults 10

bull Shop class account for 7

bull In 31 of states and 90 of districts schools are required to write an injury report when a student is seriously injured on school property

bull Among the states that require injury reports only two require districts or schools to submit injury report data to the state education agency or state health department

bullMale are injured 15 times more femalesbull Males are 3 times more to ERbull Middle and high school students sustain more injuries at than elementary school bullStudentsbull 41 are aged 15--19 yearsbull 31 are aged 11--14 years bull28 are aged 5--10 years

Sports-Related Injuries 8 million high school students participate in school- or community-sponsored sports annually

Approximately one million serious (ie injuries resulting in hospitalization surgical treatment missed school or one half day or more in bed) sports-related injuries occur annually to adolescents aged 10--17 years accounting for one third of all serious injuries in this age group

Develop Systematic Approach to the Evaluation and Management of Injuries

bullPrevention of further in jurybullMinimizes problemsComplicationsbullPractice make PerfectbullCall for helpbullImprovisebullReflect and reassess

Do the same thing every time

PRICEbullPROCTECTIONbullRESTbullICEbullCOMPRESSIONbullELEVATION

In 1997 sprains and strains were the injury conditions most frequently reported followed by open wounds fractures and contusions

Information on the site of the injury is now available and shows that injuries to the upper and lower extremities were most common

Current Trends Playground-Related Injuries in Preschool-Aged Children -- United States 1983-1987

From 1983 to 1987 nearly 672 million emergency room visits in the United States were for product-related injuries among preschool children 1-4 years old

Approximately 305000 (45) of these injuries involved playground equipment

These playground equipment-related injuries occurred most frequently at home (383) in sports or recreation settings (294) or at school (89)

Of the 82108 injuries in preschool-aged children attending day care (coded as occurring at school) 27232 (332) were related to playground equipment

bullA higher proportion of playground- related injuries occurred in the spring than at other times of the year

bullMost preschool-aged children with injuries involving school playground equipment were 3 or 4 years old and male

bullForty percent of playground-related injuries were associated with climbing apparatus

bull Two thirds of injuries were to the head and neck

Lacerations (385) contusions or abrasions (268) fractures (168) strains or sprains (44) and concussions (17) were most commonly reported (Table 2)

Head and neck injuries were primarily lacerations (557) and contusions or abrasions (237)

Injury to the extremities and trunk included mostly fractures contusions or abrasions and strains or sprains (upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 of preschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Reported by Div of Injury Epidemiology and Control Center for Environmental Health and Injury Control CDC

Injury to the extremities and trunk included

Mostly fracturesContusions or abrasions and strains or sprains

(Upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 ofpreschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Each year in the United States an estimated one in six residents requires medical treatment for an injury and an estimated one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury

This report summarizes national data on fatal and nonfatal injuries in the United States for 2001 by age sex mechanism intent and type of injury and other selected characteristics Reporting Period January--December 2001

For nonfatal injuries the majority of injured persons were treated in hospital EDs for

bull Lacerations (258) bull Strainssprains (202) bull Contusionsabrasions (183) bull Headneck region (295) majority bull Extremities (479)

Overall 55 of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care

Management

Quick and Dirty AssessmentABCrsquoSC-SPINENeurologicDeformities -PulsesWhen to call for helpCall parentsWhatrsquos in the Bag

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

Injuries requiring medical attention or resulting in restricted activity affect approximately 20 million children and adolescents (2501000 persons) and cost of $17 billion annually in medical costs

Approximately 74 million adolescents aged 15--24 years sustain injuries requiring ER visits annually (2101 per 1000 persons)

Injuries requiring medical attention or resulting in restricted activity affect approximately 20 million children and adolescents (2501000 persons)

Cost of

$17 Billion Annually in

Medical costs

bull One study reported that 80 of elementary school children visited the school nurse for an injury-related

complaint bullInjury rate ~ 10--25 of children occur on school

premises bull Approximately 4 million kids are injured at school year

However the majority of school injuries are minor

Serious injuries are more likely to occur at home or in the community

(EMS) dispatches to schools represent 6of all EMS incidents for school-aged children

Fatalities at school are rare approximately 1 in 400 injury-related fatalities in children aged 5--19 years

occur at school

Injuries at school are most likely to occur on playgrounds (particularly on climbing equipment) on athletic fields and in gymnasiums

The majority of injuries at school are unintentional not violent

The most frequent causes of school-associated injuries resulting in ER visits

bull Falls (43)

bullSports activities (34)

bullAssaults 10

bull Shop class account for 7

bull In 31 of states and 90 of districts schools are required to write an injury report when a student is seriously injured on school property

bull Among the states that require injury reports only two require districts or schools to submit injury report data to the state education agency or state health department

bullMale are injured 15 times more femalesbull Males are 3 times more to ERbull Middle and high school students sustain more injuries at than elementary school bullStudentsbull 41 are aged 15--19 yearsbull 31 are aged 11--14 years bull28 are aged 5--10 years

Sports-Related Injuries 8 million high school students participate in school- or community-sponsored sports annually

Approximately one million serious (ie injuries resulting in hospitalization surgical treatment missed school or one half day or more in bed) sports-related injuries occur annually to adolescents aged 10--17 years accounting for one third of all serious injuries in this age group

Develop Systematic Approach to the Evaluation and Management of Injuries

bullPrevention of further in jurybullMinimizes problemsComplicationsbullPractice make PerfectbullCall for helpbullImprovisebullReflect and reassess

Do the same thing every time

PRICEbullPROCTECTIONbullRESTbullICEbullCOMPRESSIONbullELEVATION

In 1997 sprains and strains were the injury conditions most frequently reported followed by open wounds fractures and contusions

Information on the site of the injury is now available and shows that injuries to the upper and lower extremities were most common

Current Trends Playground-Related Injuries in Preschool-Aged Children -- United States 1983-1987

From 1983 to 1987 nearly 672 million emergency room visits in the United States were for product-related injuries among preschool children 1-4 years old

Approximately 305000 (45) of these injuries involved playground equipment

These playground equipment-related injuries occurred most frequently at home (383) in sports or recreation settings (294) or at school (89)

Of the 82108 injuries in preschool-aged children attending day care (coded as occurring at school) 27232 (332) were related to playground equipment

bullA higher proportion of playground- related injuries occurred in the spring than at other times of the year

bullMost preschool-aged children with injuries involving school playground equipment were 3 or 4 years old and male

bullForty percent of playground-related injuries were associated with climbing apparatus

bull Two thirds of injuries were to the head and neck

Lacerations (385) contusions or abrasions (268) fractures (168) strains or sprains (44) and concussions (17) were most commonly reported (Table 2)

Head and neck injuries were primarily lacerations (557) and contusions or abrasions (237)

Injury to the extremities and trunk included mostly fractures contusions or abrasions and strains or sprains (upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 of preschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Reported by Div of Injury Epidemiology and Control Center for Environmental Health and Injury Control CDC

Injury to the extremities and trunk included

Mostly fracturesContusions or abrasions and strains or sprains

(Upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 ofpreschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Each year in the United States an estimated one in six residents requires medical treatment for an injury and an estimated one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury

This report summarizes national data on fatal and nonfatal injuries in the United States for 2001 by age sex mechanism intent and type of injury and other selected characteristics Reporting Period January--December 2001

For nonfatal injuries the majority of injured persons were treated in hospital EDs for

bull Lacerations (258) bull Strainssprains (202) bull Contusionsabrasions (183) bull Headneck region (295) majority bull Extremities (479)

Overall 55 of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care

Management

Quick and Dirty AssessmentABCrsquoSC-SPINENeurologicDeformities -PulsesWhen to call for helpCall parentsWhatrsquos in the Bag

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

Approximately 74 million adolescents aged 15--24 years sustain injuries requiring ER visits annually (2101 per 1000 persons)

Injuries requiring medical attention or resulting in restricted activity affect approximately 20 million children and adolescents (2501000 persons)

Cost of

$17 Billion Annually in

Medical costs

bull One study reported that 80 of elementary school children visited the school nurse for an injury-related

complaint bullInjury rate ~ 10--25 of children occur on school

premises bull Approximately 4 million kids are injured at school year

However the majority of school injuries are minor

Serious injuries are more likely to occur at home or in the community

(EMS) dispatches to schools represent 6of all EMS incidents for school-aged children

Fatalities at school are rare approximately 1 in 400 injury-related fatalities in children aged 5--19 years

occur at school

Injuries at school are most likely to occur on playgrounds (particularly on climbing equipment) on athletic fields and in gymnasiums

The majority of injuries at school are unintentional not violent

The most frequent causes of school-associated injuries resulting in ER visits

bull Falls (43)

bullSports activities (34)

bullAssaults 10

bull Shop class account for 7

bull In 31 of states and 90 of districts schools are required to write an injury report when a student is seriously injured on school property

bull Among the states that require injury reports only two require districts or schools to submit injury report data to the state education agency or state health department

bullMale are injured 15 times more femalesbull Males are 3 times more to ERbull Middle and high school students sustain more injuries at than elementary school bullStudentsbull 41 are aged 15--19 yearsbull 31 are aged 11--14 years bull28 are aged 5--10 years

Sports-Related Injuries 8 million high school students participate in school- or community-sponsored sports annually

Approximately one million serious (ie injuries resulting in hospitalization surgical treatment missed school or one half day or more in bed) sports-related injuries occur annually to adolescents aged 10--17 years accounting for one third of all serious injuries in this age group

Develop Systematic Approach to the Evaluation and Management of Injuries

bullPrevention of further in jurybullMinimizes problemsComplicationsbullPractice make PerfectbullCall for helpbullImprovisebullReflect and reassess

Do the same thing every time

PRICEbullPROCTECTIONbullRESTbullICEbullCOMPRESSIONbullELEVATION

In 1997 sprains and strains were the injury conditions most frequently reported followed by open wounds fractures and contusions

Information on the site of the injury is now available and shows that injuries to the upper and lower extremities were most common

Current Trends Playground-Related Injuries in Preschool-Aged Children -- United States 1983-1987

From 1983 to 1987 nearly 672 million emergency room visits in the United States were for product-related injuries among preschool children 1-4 years old

Approximately 305000 (45) of these injuries involved playground equipment

These playground equipment-related injuries occurred most frequently at home (383) in sports or recreation settings (294) or at school (89)

Of the 82108 injuries in preschool-aged children attending day care (coded as occurring at school) 27232 (332) were related to playground equipment

bullA higher proportion of playground- related injuries occurred in the spring than at other times of the year

bullMost preschool-aged children with injuries involving school playground equipment were 3 or 4 years old and male

bullForty percent of playground-related injuries were associated with climbing apparatus

bull Two thirds of injuries were to the head and neck

Lacerations (385) contusions or abrasions (268) fractures (168) strains or sprains (44) and concussions (17) were most commonly reported (Table 2)

Head and neck injuries were primarily lacerations (557) and contusions or abrasions (237)

Injury to the extremities and trunk included mostly fractures contusions or abrasions and strains or sprains (upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 of preschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Reported by Div of Injury Epidemiology and Control Center for Environmental Health and Injury Control CDC

Injury to the extremities and trunk included

Mostly fracturesContusions or abrasions and strains or sprains

(Upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 ofpreschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Each year in the United States an estimated one in six residents requires medical treatment for an injury and an estimated one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury

This report summarizes national data on fatal and nonfatal injuries in the United States for 2001 by age sex mechanism intent and type of injury and other selected characteristics Reporting Period January--December 2001

For nonfatal injuries the majority of injured persons were treated in hospital EDs for

bull Lacerations (258) bull Strainssprains (202) bull Contusionsabrasions (183) bull Headneck region (295) majority bull Extremities (479)

Overall 55 of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care

Management

Quick and Dirty AssessmentABCrsquoSC-SPINENeurologicDeformities -PulsesWhen to call for helpCall parentsWhatrsquos in the Bag

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

Cost of

$17 Billion Annually in

Medical costs

bull One study reported that 80 of elementary school children visited the school nurse for an injury-related

complaint bullInjury rate ~ 10--25 of children occur on school

premises bull Approximately 4 million kids are injured at school year

However the majority of school injuries are minor

Serious injuries are more likely to occur at home or in the community

(EMS) dispatches to schools represent 6of all EMS incidents for school-aged children

Fatalities at school are rare approximately 1 in 400 injury-related fatalities in children aged 5--19 years

occur at school

Injuries at school are most likely to occur on playgrounds (particularly on climbing equipment) on athletic fields and in gymnasiums

The majority of injuries at school are unintentional not violent

The most frequent causes of school-associated injuries resulting in ER visits

bull Falls (43)

bullSports activities (34)

bullAssaults 10

bull Shop class account for 7

bull In 31 of states and 90 of districts schools are required to write an injury report when a student is seriously injured on school property

bull Among the states that require injury reports only two require districts or schools to submit injury report data to the state education agency or state health department

bullMale are injured 15 times more femalesbull Males are 3 times more to ERbull Middle and high school students sustain more injuries at than elementary school bullStudentsbull 41 are aged 15--19 yearsbull 31 are aged 11--14 years bull28 are aged 5--10 years

Sports-Related Injuries 8 million high school students participate in school- or community-sponsored sports annually

Approximately one million serious (ie injuries resulting in hospitalization surgical treatment missed school or one half day or more in bed) sports-related injuries occur annually to adolescents aged 10--17 years accounting for one third of all serious injuries in this age group

Develop Systematic Approach to the Evaluation and Management of Injuries

bullPrevention of further in jurybullMinimizes problemsComplicationsbullPractice make PerfectbullCall for helpbullImprovisebullReflect and reassess

Do the same thing every time

PRICEbullPROCTECTIONbullRESTbullICEbullCOMPRESSIONbullELEVATION

In 1997 sprains and strains were the injury conditions most frequently reported followed by open wounds fractures and contusions

Information on the site of the injury is now available and shows that injuries to the upper and lower extremities were most common

Current Trends Playground-Related Injuries in Preschool-Aged Children -- United States 1983-1987

From 1983 to 1987 nearly 672 million emergency room visits in the United States were for product-related injuries among preschool children 1-4 years old

Approximately 305000 (45) of these injuries involved playground equipment

These playground equipment-related injuries occurred most frequently at home (383) in sports or recreation settings (294) or at school (89)

Of the 82108 injuries in preschool-aged children attending day care (coded as occurring at school) 27232 (332) were related to playground equipment

bullA higher proportion of playground- related injuries occurred in the spring than at other times of the year

bullMost preschool-aged children with injuries involving school playground equipment were 3 or 4 years old and male

bullForty percent of playground-related injuries were associated with climbing apparatus

bull Two thirds of injuries were to the head and neck

Lacerations (385) contusions or abrasions (268) fractures (168) strains or sprains (44) and concussions (17) were most commonly reported (Table 2)

Head and neck injuries were primarily lacerations (557) and contusions or abrasions (237)

Injury to the extremities and trunk included mostly fractures contusions or abrasions and strains or sprains (upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 of preschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Reported by Div of Injury Epidemiology and Control Center for Environmental Health and Injury Control CDC

Injury to the extremities and trunk included

Mostly fracturesContusions or abrasions and strains or sprains

(Upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 ofpreschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Each year in the United States an estimated one in six residents requires medical treatment for an injury and an estimated one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury

This report summarizes national data on fatal and nonfatal injuries in the United States for 2001 by age sex mechanism intent and type of injury and other selected characteristics Reporting Period January--December 2001

For nonfatal injuries the majority of injured persons were treated in hospital EDs for

bull Lacerations (258) bull Strainssprains (202) bull Contusionsabrasions (183) bull Headneck region (295) majority bull Extremities (479)

Overall 55 of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care

Management

Quick and Dirty AssessmentABCrsquoSC-SPINENeurologicDeformities -PulsesWhen to call for helpCall parentsWhatrsquos in the Bag

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

bull One study reported that 80 of elementary school children visited the school nurse for an injury-related

complaint bullInjury rate ~ 10--25 of children occur on school

premises bull Approximately 4 million kids are injured at school year

However the majority of school injuries are minor

Serious injuries are more likely to occur at home or in the community

(EMS) dispatches to schools represent 6of all EMS incidents for school-aged children

Fatalities at school are rare approximately 1 in 400 injury-related fatalities in children aged 5--19 years

occur at school

Injuries at school are most likely to occur on playgrounds (particularly on climbing equipment) on athletic fields and in gymnasiums

The majority of injuries at school are unintentional not violent

The most frequent causes of school-associated injuries resulting in ER visits

bull Falls (43)

bullSports activities (34)

bullAssaults 10

bull Shop class account for 7

bull In 31 of states and 90 of districts schools are required to write an injury report when a student is seriously injured on school property

bull Among the states that require injury reports only two require districts or schools to submit injury report data to the state education agency or state health department

bullMale are injured 15 times more femalesbull Males are 3 times more to ERbull Middle and high school students sustain more injuries at than elementary school bullStudentsbull 41 are aged 15--19 yearsbull 31 are aged 11--14 years bull28 are aged 5--10 years

Sports-Related Injuries 8 million high school students participate in school- or community-sponsored sports annually

Approximately one million serious (ie injuries resulting in hospitalization surgical treatment missed school or one half day or more in bed) sports-related injuries occur annually to adolescents aged 10--17 years accounting for one third of all serious injuries in this age group

Develop Systematic Approach to the Evaluation and Management of Injuries

bullPrevention of further in jurybullMinimizes problemsComplicationsbullPractice make PerfectbullCall for helpbullImprovisebullReflect and reassess

Do the same thing every time

PRICEbullPROCTECTIONbullRESTbullICEbullCOMPRESSIONbullELEVATION

In 1997 sprains and strains were the injury conditions most frequently reported followed by open wounds fractures and contusions

Information on the site of the injury is now available and shows that injuries to the upper and lower extremities were most common

Current Trends Playground-Related Injuries in Preschool-Aged Children -- United States 1983-1987

From 1983 to 1987 nearly 672 million emergency room visits in the United States were for product-related injuries among preschool children 1-4 years old

Approximately 305000 (45) of these injuries involved playground equipment

These playground equipment-related injuries occurred most frequently at home (383) in sports or recreation settings (294) or at school (89)

Of the 82108 injuries in preschool-aged children attending day care (coded as occurring at school) 27232 (332) were related to playground equipment

bullA higher proportion of playground- related injuries occurred in the spring than at other times of the year

bullMost preschool-aged children with injuries involving school playground equipment were 3 or 4 years old and male

bullForty percent of playground-related injuries were associated with climbing apparatus

bull Two thirds of injuries were to the head and neck

Lacerations (385) contusions or abrasions (268) fractures (168) strains or sprains (44) and concussions (17) were most commonly reported (Table 2)

Head and neck injuries were primarily lacerations (557) and contusions or abrasions (237)

Injury to the extremities and trunk included mostly fractures contusions or abrasions and strains or sprains (upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 of preschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Reported by Div of Injury Epidemiology and Control Center for Environmental Health and Injury Control CDC

Injury to the extremities and trunk included

Mostly fracturesContusions or abrasions and strains or sprains

(Upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 ofpreschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Each year in the United States an estimated one in six residents requires medical treatment for an injury and an estimated one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury

This report summarizes national data on fatal and nonfatal injuries in the United States for 2001 by age sex mechanism intent and type of injury and other selected characteristics Reporting Period January--December 2001

For nonfatal injuries the majority of injured persons were treated in hospital EDs for

bull Lacerations (258) bull Strainssprains (202) bull Contusionsabrasions (183) bull Headneck region (295) majority bull Extremities (479)

Overall 55 of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care

Management

Quick and Dirty AssessmentABCrsquoSC-SPINENeurologicDeformities -PulsesWhen to call for helpCall parentsWhatrsquos in the Bag

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

However the majority of school injuries are minor

Serious injuries are more likely to occur at home or in the community

(EMS) dispatches to schools represent 6of all EMS incidents for school-aged children

Fatalities at school are rare approximately 1 in 400 injury-related fatalities in children aged 5--19 years

occur at school

Injuries at school are most likely to occur on playgrounds (particularly on climbing equipment) on athletic fields and in gymnasiums

The majority of injuries at school are unintentional not violent

The most frequent causes of school-associated injuries resulting in ER visits

bull Falls (43)

bullSports activities (34)

bullAssaults 10

bull Shop class account for 7

bull In 31 of states and 90 of districts schools are required to write an injury report when a student is seriously injured on school property

bull Among the states that require injury reports only two require districts or schools to submit injury report data to the state education agency or state health department

bullMale are injured 15 times more femalesbull Males are 3 times more to ERbull Middle and high school students sustain more injuries at than elementary school bullStudentsbull 41 are aged 15--19 yearsbull 31 are aged 11--14 years bull28 are aged 5--10 years

Sports-Related Injuries 8 million high school students participate in school- or community-sponsored sports annually

Approximately one million serious (ie injuries resulting in hospitalization surgical treatment missed school or one half day or more in bed) sports-related injuries occur annually to adolescents aged 10--17 years accounting for one third of all serious injuries in this age group

Develop Systematic Approach to the Evaluation and Management of Injuries

bullPrevention of further in jurybullMinimizes problemsComplicationsbullPractice make PerfectbullCall for helpbullImprovisebullReflect and reassess

Do the same thing every time

PRICEbullPROCTECTIONbullRESTbullICEbullCOMPRESSIONbullELEVATION

In 1997 sprains and strains were the injury conditions most frequently reported followed by open wounds fractures and contusions

Information on the site of the injury is now available and shows that injuries to the upper and lower extremities were most common

Current Trends Playground-Related Injuries in Preschool-Aged Children -- United States 1983-1987

From 1983 to 1987 nearly 672 million emergency room visits in the United States were for product-related injuries among preschool children 1-4 years old

Approximately 305000 (45) of these injuries involved playground equipment

These playground equipment-related injuries occurred most frequently at home (383) in sports or recreation settings (294) or at school (89)

Of the 82108 injuries in preschool-aged children attending day care (coded as occurring at school) 27232 (332) were related to playground equipment

bullA higher proportion of playground- related injuries occurred in the spring than at other times of the year

bullMost preschool-aged children with injuries involving school playground equipment were 3 or 4 years old and male

bullForty percent of playground-related injuries were associated with climbing apparatus

bull Two thirds of injuries were to the head and neck

Lacerations (385) contusions or abrasions (268) fractures (168) strains or sprains (44) and concussions (17) were most commonly reported (Table 2)

Head and neck injuries were primarily lacerations (557) and contusions or abrasions (237)

Injury to the extremities and trunk included mostly fractures contusions or abrasions and strains or sprains (upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 of preschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Reported by Div of Injury Epidemiology and Control Center for Environmental Health and Injury Control CDC

Injury to the extremities and trunk included

Mostly fracturesContusions or abrasions and strains or sprains

(Upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 ofpreschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Each year in the United States an estimated one in six residents requires medical treatment for an injury and an estimated one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury

This report summarizes national data on fatal and nonfatal injuries in the United States for 2001 by age sex mechanism intent and type of injury and other selected characteristics Reporting Period January--December 2001

For nonfatal injuries the majority of injured persons were treated in hospital EDs for

bull Lacerations (258) bull Strainssprains (202) bull Contusionsabrasions (183) bull Headneck region (295) majority bull Extremities (479)

Overall 55 of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care

Management

Quick and Dirty AssessmentABCrsquoSC-SPINENeurologicDeformities -PulsesWhen to call for helpCall parentsWhatrsquos in the Bag

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

Injuries at school are most likely to occur on playgrounds (particularly on climbing equipment) on athletic fields and in gymnasiums

The majority of injuries at school are unintentional not violent

The most frequent causes of school-associated injuries resulting in ER visits

bull Falls (43)

bullSports activities (34)

bullAssaults 10

bull Shop class account for 7

bull In 31 of states and 90 of districts schools are required to write an injury report when a student is seriously injured on school property

bull Among the states that require injury reports only two require districts or schools to submit injury report data to the state education agency or state health department

bullMale are injured 15 times more femalesbull Males are 3 times more to ERbull Middle and high school students sustain more injuries at than elementary school bullStudentsbull 41 are aged 15--19 yearsbull 31 are aged 11--14 years bull28 are aged 5--10 years

Sports-Related Injuries 8 million high school students participate in school- or community-sponsored sports annually

Approximately one million serious (ie injuries resulting in hospitalization surgical treatment missed school or one half day or more in bed) sports-related injuries occur annually to adolescents aged 10--17 years accounting for one third of all serious injuries in this age group

Develop Systematic Approach to the Evaluation and Management of Injuries

bullPrevention of further in jurybullMinimizes problemsComplicationsbullPractice make PerfectbullCall for helpbullImprovisebullReflect and reassess

Do the same thing every time

PRICEbullPROCTECTIONbullRESTbullICEbullCOMPRESSIONbullELEVATION

In 1997 sprains and strains were the injury conditions most frequently reported followed by open wounds fractures and contusions

Information on the site of the injury is now available and shows that injuries to the upper and lower extremities were most common

Current Trends Playground-Related Injuries in Preschool-Aged Children -- United States 1983-1987

From 1983 to 1987 nearly 672 million emergency room visits in the United States were for product-related injuries among preschool children 1-4 years old

Approximately 305000 (45) of these injuries involved playground equipment

These playground equipment-related injuries occurred most frequently at home (383) in sports or recreation settings (294) or at school (89)

Of the 82108 injuries in preschool-aged children attending day care (coded as occurring at school) 27232 (332) were related to playground equipment

bullA higher proportion of playground- related injuries occurred in the spring than at other times of the year

bullMost preschool-aged children with injuries involving school playground equipment were 3 or 4 years old and male

bullForty percent of playground-related injuries were associated with climbing apparatus

bull Two thirds of injuries were to the head and neck

Lacerations (385) contusions or abrasions (268) fractures (168) strains or sprains (44) and concussions (17) were most commonly reported (Table 2)

Head and neck injuries were primarily lacerations (557) and contusions or abrasions (237)

Injury to the extremities and trunk included mostly fractures contusions or abrasions and strains or sprains (upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 of preschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Reported by Div of Injury Epidemiology and Control Center for Environmental Health and Injury Control CDC

Injury to the extremities and trunk included

Mostly fracturesContusions or abrasions and strains or sprains

(Upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 ofpreschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Each year in the United States an estimated one in six residents requires medical treatment for an injury and an estimated one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury

This report summarizes national data on fatal and nonfatal injuries in the United States for 2001 by age sex mechanism intent and type of injury and other selected characteristics Reporting Period January--December 2001

For nonfatal injuries the majority of injured persons were treated in hospital EDs for

bull Lacerations (258) bull Strainssprains (202) bull Contusionsabrasions (183) bull Headneck region (295) majority bull Extremities (479)

Overall 55 of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care

Management

Quick and Dirty AssessmentABCrsquoSC-SPINENeurologicDeformities -PulsesWhen to call for helpCall parentsWhatrsquos in the Bag

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

The majority of injuries at school are unintentional not violent

The most frequent causes of school-associated injuries resulting in ER visits

bull Falls (43)

bullSports activities (34)

bullAssaults 10

bull Shop class account for 7

bull In 31 of states and 90 of districts schools are required to write an injury report when a student is seriously injured on school property

bull Among the states that require injury reports only two require districts or schools to submit injury report data to the state education agency or state health department

bullMale are injured 15 times more femalesbull Males are 3 times more to ERbull Middle and high school students sustain more injuries at than elementary school bullStudentsbull 41 are aged 15--19 yearsbull 31 are aged 11--14 years bull28 are aged 5--10 years

Sports-Related Injuries 8 million high school students participate in school- or community-sponsored sports annually

Approximately one million serious (ie injuries resulting in hospitalization surgical treatment missed school or one half day or more in bed) sports-related injuries occur annually to adolescents aged 10--17 years accounting for one third of all serious injuries in this age group

Develop Systematic Approach to the Evaluation and Management of Injuries

bullPrevention of further in jurybullMinimizes problemsComplicationsbullPractice make PerfectbullCall for helpbullImprovisebullReflect and reassess

Do the same thing every time

PRICEbullPROCTECTIONbullRESTbullICEbullCOMPRESSIONbullELEVATION

In 1997 sprains and strains were the injury conditions most frequently reported followed by open wounds fractures and contusions

Information on the site of the injury is now available and shows that injuries to the upper and lower extremities were most common

Current Trends Playground-Related Injuries in Preschool-Aged Children -- United States 1983-1987

From 1983 to 1987 nearly 672 million emergency room visits in the United States were for product-related injuries among preschool children 1-4 years old

Approximately 305000 (45) of these injuries involved playground equipment

These playground equipment-related injuries occurred most frequently at home (383) in sports or recreation settings (294) or at school (89)

Of the 82108 injuries in preschool-aged children attending day care (coded as occurring at school) 27232 (332) were related to playground equipment

bullA higher proportion of playground- related injuries occurred in the spring than at other times of the year

bullMost preschool-aged children with injuries involving school playground equipment were 3 or 4 years old and male

bullForty percent of playground-related injuries were associated with climbing apparatus

bull Two thirds of injuries were to the head and neck

Lacerations (385) contusions or abrasions (268) fractures (168) strains or sprains (44) and concussions (17) were most commonly reported (Table 2)

Head and neck injuries were primarily lacerations (557) and contusions or abrasions (237)

Injury to the extremities and trunk included mostly fractures contusions or abrasions and strains or sprains (upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 of preschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Reported by Div of Injury Epidemiology and Control Center for Environmental Health and Injury Control CDC

Injury to the extremities and trunk included

Mostly fracturesContusions or abrasions and strains or sprains

(Upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 ofpreschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Each year in the United States an estimated one in six residents requires medical treatment for an injury and an estimated one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury

This report summarizes national data on fatal and nonfatal injuries in the United States for 2001 by age sex mechanism intent and type of injury and other selected characteristics Reporting Period January--December 2001

For nonfatal injuries the majority of injured persons were treated in hospital EDs for

bull Lacerations (258) bull Strainssprains (202) bull Contusionsabrasions (183) bull Headneck region (295) majority bull Extremities (479)

Overall 55 of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care

Management

Quick and Dirty AssessmentABCrsquoSC-SPINENeurologicDeformities -PulsesWhen to call for helpCall parentsWhatrsquos in the Bag

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

The most frequent causes of school-associated injuries resulting in ER visits

bull Falls (43)

bullSports activities (34)

bullAssaults 10

bull Shop class account for 7

bull In 31 of states and 90 of districts schools are required to write an injury report when a student is seriously injured on school property

bull Among the states that require injury reports only two require districts or schools to submit injury report data to the state education agency or state health department

bullMale are injured 15 times more femalesbull Males are 3 times more to ERbull Middle and high school students sustain more injuries at than elementary school bullStudentsbull 41 are aged 15--19 yearsbull 31 are aged 11--14 years bull28 are aged 5--10 years

Sports-Related Injuries 8 million high school students participate in school- or community-sponsored sports annually

Approximately one million serious (ie injuries resulting in hospitalization surgical treatment missed school or one half day or more in bed) sports-related injuries occur annually to adolescents aged 10--17 years accounting for one third of all serious injuries in this age group

Develop Systematic Approach to the Evaluation and Management of Injuries

bullPrevention of further in jurybullMinimizes problemsComplicationsbullPractice make PerfectbullCall for helpbullImprovisebullReflect and reassess

Do the same thing every time

PRICEbullPROCTECTIONbullRESTbullICEbullCOMPRESSIONbullELEVATION

In 1997 sprains and strains were the injury conditions most frequently reported followed by open wounds fractures and contusions

Information on the site of the injury is now available and shows that injuries to the upper and lower extremities were most common

Current Trends Playground-Related Injuries in Preschool-Aged Children -- United States 1983-1987

From 1983 to 1987 nearly 672 million emergency room visits in the United States were for product-related injuries among preschool children 1-4 years old

Approximately 305000 (45) of these injuries involved playground equipment

These playground equipment-related injuries occurred most frequently at home (383) in sports or recreation settings (294) or at school (89)

Of the 82108 injuries in preschool-aged children attending day care (coded as occurring at school) 27232 (332) were related to playground equipment

bullA higher proportion of playground- related injuries occurred in the spring than at other times of the year

bullMost preschool-aged children with injuries involving school playground equipment were 3 or 4 years old and male

bullForty percent of playground-related injuries were associated with climbing apparatus

bull Two thirds of injuries were to the head and neck

Lacerations (385) contusions or abrasions (268) fractures (168) strains or sprains (44) and concussions (17) were most commonly reported (Table 2)

Head and neck injuries were primarily lacerations (557) and contusions or abrasions (237)

Injury to the extremities and trunk included mostly fractures contusions or abrasions and strains or sprains (upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 of preschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Reported by Div of Injury Epidemiology and Control Center for Environmental Health and Injury Control CDC

Injury to the extremities and trunk included

Mostly fracturesContusions or abrasions and strains or sprains

(Upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 ofpreschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Each year in the United States an estimated one in six residents requires medical treatment for an injury and an estimated one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury

This report summarizes national data on fatal and nonfatal injuries in the United States for 2001 by age sex mechanism intent and type of injury and other selected characteristics Reporting Period January--December 2001

For nonfatal injuries the majority of injured persons were treated in hospital EDs for

bull Lacerations (258) bull Strainssprains (202) bull Contusionsabrasions (183) bull Headneck region (295) majority bull Extremities (479)

Overall 55 of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care

Management

Quick and Dirty AssessmentABCrsquoSC-SPINENeurologicDeformities -PulsesWhen to call for helpCall parentsWhatrsquos in the Bag

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

bull In 31 of states and 90 of districts schools are required to write an injury report when a student is seriously injured on school property

bull Among the states that require injury reports only two require districts or schools to submit injury report data to the state education agency or state health department

bullMale are injured 15 times more femalesbull Males are 3 times more to ERbull Middle and high school students sustain more injuries at than elementary school bullStudentsbull 41 are aged 15--19 yearsbull 31 are aged 11--14 years bull28 are aged 5--10 years

Sports-Related Injuries 8 million high school students participate in school- or community-sponsored sports annually

Approximately one million serious (ie injuries resulting in hospitalization surgical treatment missed school or one half day or more in bed) sports-related injuries occur annually to adolescents aged 10--17 years accounting for one third of all serious injuries in this age group

Develop Systematic Approach to the Evaluation and Management of Injuries

bullPrevention of further in jurybullMinimizes problemsComplicationsbullPractice make PerfectbullCall for helpbullImprovisebullReflect and reassess

Do the same thing every time

PRICEbullPROCTECTIONbullRESTbullICEbullCOMPRESSIONbullELEVATION

In 1997 sprains and strains were the injury conditions most frequently reported followed by open wounds fractures and contusions

Information on the site of the injury is now available and shows that injuries to the upper and lower extremities were most common

Current Trends Playground-Related Injuries in Preschool-Aged Children -- United States 1983-1987

From 1983 to 1987 nearly 672 million emergency room visits in the United States were for product-related injuries among preschool children 1-4 years old

Approximately 305000 (45) of these injuries involved playground equipment

These playground equipment-related injuries occurred most frequently at home (383) in sports or recreation settings (294) or at school (89)

Of the 82108 injuries in preschool-aged children attending day care (coded as occurring at school) 27232 (332) were related to playground equipment

bullA higher proportion of playground- related injuries occurred in the spring than at other times of the year

bullMost preschool-aged children with injuries involving school playground equipment were 3 or 4 years old and male

bullForty percent of playground-related injuries were associated with climbing apparatus

bull Two thirds of injuries were to the head and neck

Lacerations (385) contusions or abrasions (268) fractures (168) strains or sprains (44) and concussions (17) were most commonly reported (Table 2)

Head and neck injuries were primarily lacerations (557) and contusions or abrasions (237)

Injury to the extremities and trunk included mostly fractures contusions or abrasions and strains or sprains (upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 of preschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Reported by Div of Injury Epidemiology and Control Center for Environmental Health and Injury Control CDC

Injury to the extremities and trunk included

Mostly fracturesContusions or abrasions and strains or sprains

(Upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 ofpreschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Each year in the United States an estimated one in six residents requires medical treatment for an injury and an estimated one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury

This report summarizes national data on fatal and nonfatal injuries in the United States for 2001 by age sex mechanism intent and type of injury and other selected characteristics Reporting Period January--December 2001

For nonfatal injuries the majority of injured persons were treated in hospital EDs for

bull Lacerations (258) bull Strainssprains (202) bull Contusionsabrasions (183) bull Headneck region (295) majority bull Extremities (479)

Overall 55 of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care

Management

Quick and Dirty AssessmentABCrsquoSC-SPINENeurologicDeformities -PulsesWhen to call for helpCall parentsWhatrsquos in the Bag

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

bullMale are injured 15 times more femalesbull Males are 3 times more to ERbull Middle and high school students sustain more injuries at than elementary school bullStudentsbull 41 are aged 15--19 yearsbull 31 are aged 11--14 years bull28 are aged 5--10 years

Sports-Related Injuries 8 million high school students participate in school- or community-sponsored sports annually

Approximately one million serious (ie injuries resulting in hospitalization surgical treatment missed school or one half day or more in bed) sports-related injuries occur annually to adolescents aged 10--17 years accounting for one third of all serious injuries in this age group

Develop Systematic Approach to the Evaluation and Management of Injuries

bullPrevention of further in jurybullMinimizes problemsComplicationsbullPractice make PerfectbullCall for helpbullImprovisebullReflect and reassess

Do the same thing every time

PRICEbullPROCTECTIONbullRESTbullICEbullCOMPRESSIONbullELEVATION

In 1997 sprains and strains were the injury conditions most frequently reported followed by open wounds fractures and contusions

Information on the site of the injury is now available and shows that injuries to the upper and lower extremities were most common

Current Trends Playground-Related Injuries in Preschool-Aged Children -- United States 1983-1987

From 1983 to 1987 nearly 672 million emergency room visits in the United States were for product-related injuries among preschool children 1-4 years old

Approximately 305000 (45) of these injuries involved playground equipment

These playground equipment-related injuries occurred most frequently at home (383) in sports or recreation settings (294) or at school (89)

Of the 82108 injuries in preschool-aged children attending day care (coded as occurring at school) 27232 (332) were related to playground equipment

bullA higher proportion of playground- related injuries occurred in the spring than at other times of the year

bullMost preschool-aged children with injuries involving school playground equipment were 3 or 4 years old and male

bullForty percent of playground-related injuries were associated with climbing apparatus

bull Two thirds of injuries were to the head and neck

Lacerations (385) contusions or abrasions (268) fractures (168) strains or sprains (44) and concussions (17) were most commonly reported (Table 2)

Head and neck injuries were primarily lacerations (557) and contusions or abrasions (237)

Injury to the extremities and trunk included mostly fractures contusions or abrasions and strains or sprains (upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 of preschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Reported by Div of Injury Epidemiology and Control Center for Environmental Health and Injury Control CDC

Injury to the extremities and trunk included

Mostly fracturesContusions or abrasions and strains or sprains

(Upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 ofpreschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Each year in the United States an estimated one in six residents requires medical treatment for an injury and an estimated one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury

This report summarizes national data on fatal and nonfatal injuries in the United States for 2001 by age sex mechanism intent and type of injury and other selected characteristics Reporting Period January--December 2001

For nonfatal injuries the majority of injured persons were treated in hospital EDs for

bull Lacerations (258) bull Strainssprains (202) bull Contusionsabrasions (183) bull Headneck region (295) majority bull Extremities (479)

Overall 55 of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care

Management

Quick and Dirty AssessmentABCrsquoSC-SPINENeurologicDeformities -PulsesWhen to call for helpCall parentsWhatrsquos in the Bag

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

Sports-Related Injuries 8 million high school students participate in school- or community-sponsored sports annually

Approximately one million serious (ie injuries resulting in hospitalization surgical treatment missed school or one half day or more in bed) sports-related injuries occur annually to adolescents aged 10--17 years accounting for one third of all serious injuries in this age group

Develop Systematic Approach to the Evaluation and Management of Injuries

bullPrevention of further in jurybullMinimizes problemsComplicationsbullPractice make PerfectbullCall for helpbullImprovisebullReflect and reassess

Do the same thing every time

PRICEbullPROCTECTIONbullRESTbullICEbullCOMPRESSIONbullELEVATION

In 1997 sprains and strains were the injury conditions most frequently reported followed by open wounds fractures and contusions

Information on the site of the injury is now available and shows that injuries to the upper and lower extremities were most common

Current Trends Playground-Related Injuries in Preschool-Aged Children -- United States 1983-1987

From 1983 to 1987 nearly 672 million emergency room visits in the United States were for product-related injuries among preschool children 1-4 years old

Approximately 305000 (45) of these injuries involved playground equipment

These playground equipment-related injuries occurred most frequently at home (383) in sports or recreation settings (294) or at school (89)

Of the 82108 injuries in preschool-aged children attending day care (coded as occurring at school) 27232 (332) were related to playground equipment

bullA higher proportion of playground- related injuries occurred in the spring than at other times of the year

bullMost preschool-aged children with injuries involving school playground equipment were 3 or 4 years old and male

bullForty percent of playground-related injuries were associated with climbing apparatus

bull Two thirds of injuries were to the head and neck

Lacerations (385) contusions or abrasions (268) fractures (168) strains or sprains (44) and concussions (17) were most commonly reported (Table 2)

Head and neck injuries were primarily lacerations (557) and contusions or abrasions (237)

Injury to the extremities and trunk included mostly fractures contusions or abrasions and strains or sprains (upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 of preschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Reported by Div of Injury Epidemiology and Control Center for Environmental Health and Injury Control CDC

Injury to the extremities and trunk included

Mostly fracturesContusions or abrasions and strains or sprains

(Upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 ofpreschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Each year in the United States an estimated one in six residents requires medical treatment for an injury and an estimated one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury

This report summarizes national data on fatal and nonfatal injuries in the United States for 2001 by age sex mechanism intent and type of injury and other selected characteristics Reporting Period January--December 2001

For nonfatal injuries the majority of injured persons were treated in hospital EDs for

bull Lacerations (258) bull Strainssprains (202) bull Contusionsabrasions (183) bull Headneck region (295) majority bull Extremities (479)

Overall 55 of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care

Management

Quick and Dirty AssessmentABCrsquoSC-SPINENeurologicDeformities -PulsesWhen to call for helpCall parentsWhatrsquos in the Bag

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

Develop Systematic Approach to the Evaluation and Management of Injuries

bullPrevention of further in jurybullMinimizes problemsComplicationsbullPractice make PerfectbullCall for helpbullImprovisebullReflect and reassess

Do the same thing every time

PRICEbullPROCTECTIONbullRESTbullICEbullCOMPRESSIONbullELEVATION

In 1997 sprains and strains were the injury conditions most frequently reported followed by open wounds fractures and contusions

Information on the site of the injury is now available and shows that injuries to the upper and lower extremities were most common

Current Trends Playground-Related Injuries in Preschool-Aged Children -- United States 1983-1987

From 1983 to 1987 nearly 672 million emergency room visits in the United States were for product-related injuries among preschool children 1-4 years old

Approximately 305000 (45) of these injuries involved playground equipment

These playground equipment-related injuries occurred most frequently at home (383) in sports or recreation settings (294) or at school (89)

Of the 82108 injuries in preschool-aged children attending day care (coded as occurring at school) 27232 (332) were related to playground equipment

bullA higher proportion of playground- related injuries occurred in the spring than at other times of the year

bullMost preschool-aged children with injuries involving school playground equipment were 3 or 4 years old and male

bullForty percent of playground-related injuries were associated with climbing apparatus

bull Two thirds of injuries were to the head and neck

Lacerations (385) contusions or abrasions (268) fractures (168) strains or sprains (44) and concussions (17) were most commonly reported (Table 2)

Head and neck injuries were primarily lacerations (557) and contusions or abrasions (237)

Injury to the extremities and trunk included mostly fractures contusions or abrasions and strains or sprains (upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 of preschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Reported by Div of Injury Epidemiology and Control Center for Environmental Health and Injury Control CDC

Injury to the extremities and trunk included

Mostly fracturesContusions or abrasions and strains or sprains

(Upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 ofpreschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Each year in the United States an estimated one in six residents requires medical treatment for an injury and an estimated one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury

This report summarizes national data on fatal and nonfatal injuries in the United States for 2001 by age sex mechanism intent and type of injury and other selected characteristics Reporting Period January--December 2001

For nonfatal injuries the majority of injured persons were treated in hospital EDs for

bull Lacerations (258) bull Strainssprains (202) bull Contusionsabrasions (183) bull Headneck region (295) majority bull Extremities (479)

Overall 55 of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care

Management

Quick and Dirty AssessmentABCrsquoSC-SPINENeurologicDeformities -PulsesWhen to call for helpCall parentsWhatrsquos in the Bag

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

PRICEbullPROCTECTIONbullRESTbullICEbullCOMPRESSIONbullELEVATION

In 1997 sprains and strains were the injury conditions most frequently reported followed by open wounds fractures and contusions

Information on the site of the injury is now available and shows that injuries to the upper and lower extremities were most common

Current Trends Playground-Related Injuries in Preschool-Aged Children -- United States 1983-1987

From 1983 to 1987 nearly 672 million emergency room visits in the United States were for product-related injuries among preschool children 1-4 years old

Approximately 305000 (45) of these injuries involved playground equipment

These playground equipment-related injuries occurred most frequently at home (383) in sports or recreation settings (294) or at school (89)

Of the 82108 injuries in preschool-aged children attending day care (coded as occurring at school) 27232 (332) were related to playground equipment

bullA higher proportion of playground- related injuries occurred in the spring than at other times of the year

bullMost preschool-aged children with injuries involving school playground equipment were 3 or 4 years old and male

bullForty percent of playground-related injuries were associated with climbing apparatus

bull Two thirds of injuries were to the head and neck

Lacerations (385) contusions or abrasions (268) fractures (168) strains or sprains (44) and concussions (17) were most commonly reported (Table 2)

Head and neck injuries were primarily lacerations (557) and contusions or abrasions (237)

Injury to the extremities and trunk included mostly fractures contusions or abrasions and strains or sprains (upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 of preschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Reported by Div of Injury Epidemiology and Control Center for Environmental Health and Injury Control CDC

Injury to the extremities and trunk included

Mostly fracturesContusions or abrasions and strains or sprains

(Upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 ofpreschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Each year in the United States an estimated one in six residents requires medical treatment for an injury and an estimated one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury

This report summarizes national data on fatal and nonfatal injuries in the United States for 2001 by age sex mechanism intent and type of injury and other selected characteristics Reporting Period January--December 2001

For nonfatal injuries the majority of injured persons were treated in hospital EDs for

bull Lacerations (258) bull Strainssprains (202) bull Contusionsabrasions (183) bull Headneck region (295) majority bull Extremities (479)

Overall 55 of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care

Management

Quick and Dirty AssessmentABCrsquoSC-SPINENeurologicDeformities -PulsesWhen to call for helpCall parentsWhatrsquos in the Bag

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

In 1997 sprains and strains were the injury conditions most frequently reported followed by open wounds fractures and contusions

Information on the site of the injury is now available and shows that injuries to the upper and lower extremities were most common

Current Trends Playground-Related Injuries in Preschool-Aged Children -- United States 1983-1987

From 1983 to 1987 nearly 672 million emergency room visits in the United States were for product-related injuries among preschool children 1-4 years old

Approximately 305000 (45) of these injuries involved playground equipment

These playground equipment-related injuries occurred most frequently at home (383) in sports or recreation settings (294) or at school (89)

Of the 82108 injuries in preschool-aged children attending day care (coded as occurring at school) 27232 (332) were related to playground equipment

bullA higher proportion of playground- related injuries occurred in the spring than at other times of the year

bullMost preschool-aged children with injuries involving school playground equipment were 3 or 4 years old and male

bullForty percent of playground-related injuries were associated with climbing apparatus

bull Two thirds of injuries were to the head and neck

Lacerations (385) contusions or abrasions (268) fractures (168) strains or sprains (44) and concussions (17) were most commonly reported (Table 2)

Head and neck injuries were primarily lacerations (557) and contusions or abrasions (237)

Injury to the extremities and trunk included mostly fractures contusions or abrasions and strains or sprains (upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 of preschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Reported by Div of Injury Epidemiology and Control Center for Environmental Health and Injury Control CDC

Injury to the extremities and trunk included

Mostly fracturesContusions or abrasions and strains or sprains

(Upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 ofpreschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Each year in the United States an estimated one in six residents requires medical treatment for an injury and an estimated one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury

This report summarizes national data on fatal and nonfatal injuries in the United States for 2001 by age sex mechanism intent and type of injury and other selected characteristics Reporting Period January--December 2001

For nonfatal injuries the majority of injured persons were treated in hospital EDs for

bull Lacerations (258) bull Strainssprains (202) bull Contusionsabrasions (183) bull Headneck region (295) majority bull Extremities (479)

Overall 55 of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care

Management

Quick and Dirty AssessmentABCrsquoSC-SPINENeurologicDeformities -PulsesWhen to call for helpCall parentsWhatrsquos in the Bag

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

Current Trends Playground-Related Injuries in Preschool-Aged Children -- United States 1983-1987

From 1983 to 1987 nearly 672 million emergency room visits in the United States were for product-related injuries among preschool children 1-4 years old

Approximately 305000 (45) of these injuries involved playground equipment

These playground equipment-related injuries occurred most frequently at home (383) in sports or recreation settings (294) or at school (89)

Of the 82108 injuries in preschool-aged children attending day care (coded as occurring at school) 27232 (332) were related to playground equipment

bullA higher proportion of playground- related injuries occurred in the spring than at other times of the year

bullMost preschool-aged children with injuries involving school playground equipment were 3 or 4 years old and male

bullForty percent of playground-related injuries were associated with climbing apparatus

bull Two thirds of injuries were to the head and neck

Lacerations (385) contusions or abrasions (268) fractures (168) strains or sprains (44) and concussions (17) were most commonly reported (Table 2)

Head and neck injuries were primarily lacerations (557) and contusions or abrasions (237)

Injury to the extremities and trunk included mostly fractures contusions or abrasions and strains or sprains (upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 of preschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Reported by Div of Injury Epidemiology and Control Center for Environmental Health and Injury Control CDC

Injury to the extremities and trunk included

Mostly fracturesContusions or abrasions and strains or sprains

(Upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 ofpreschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Each year in the United States an estimated one in six residents requires medical treatment for an injury and an estimated one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury

This report summarizes national data on fatal and nonfatal injuries in the United States for 2001 by age sex mechanism intent and type of injury and other selected characteristics Reporting Period January--December 2001

For nonfatal injuries the majority of injured persons were treated in hospital EDs for

bull Lacerations (258) bull Strainssprains (202) bull Contusionsabrasions (183) bull Headneck region (295) majority bull Extremities (479)

Overall 55 of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care

Management

Quick and Dirty AssessmentABCrsquoSC-SPINENeurologicDeformities -PulsesWhen to call for helpCall parentsWhatrsquos in the Bag

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

Approximately 305000 (45) of these injuries involved playground equipment

These playground equipment-related injuries occurred most frequently at home (383) in sports or recreation settings (294) or at school (89)

Of the 82108 injuries in preschool-aged children attending day care (coded as occurring at school) 27232 (332) were related to playground equipment

bullA higher proportion of playground- related injuries occurred in the spring than at other times of the year

bullMost preschool-aged children with injuries involving school playground equipment were 3 or 4 years old and male

bullForty percent of playground-related injuries were associated with climbing apparatus

bull Two thirds of injuries were to the head and neck

Lacerations (385) contusions or abrasions (268) fractures (168) strains or sprains (44) and concussions (17) were most commonly reported (Table 2)

Head and neck injuries were primarily lacerations (557) and contusions or abrasions (237)

Injury to the extremities and trunk included mostly fractures contusions or abrasions and strains or sprains (upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 of preschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Reported by Div of Injury Epidemiology and Control Center for Environmental Health and Injury Control CDC

Injury to the extremities and trunk included

Mostly fracturesContusions or abrasions and strains or sprains

(Upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 ofpreschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Each year in the United States an estimated one in six residents requires medical treatment for an injury and an estimated one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury

This report summarizes national data on fatal and nonfatal injuries in the United States for 2001 by age sex mechanism intent and type of injury and other selected characteristics Reporting Period January--December 2001

For nonfatal injuries the majority of injured persons were treated in hospital EDs for

bull Lacerations (258) bull Strainssprains (202) bull Contusionsabrasions (183) bull Headneck region (295) majority bull Extremities (479)

Overall 55 of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care

Management

Quick and Dirty AssessmentABCrsquoSC-SPINENeurologicDeformities -PulsesWhen to call for helpCall parentsWhatrsquos in the Bag

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

bullA higher proportion of playground- related injuries occurred in the spring than at other times of the year

bullMost preschool-aged children with injuries involving school playground equipment were 3 or 4 years old and male

bullForty percent of playground-related injuries were associated with climbing apparatus

bull Two thirds of injuries were to the head and neck

Lacerations (385) contusions or abrasions (268) fractures (168) strains or sprains (44) and concussions (17) were most commonly reported (Table 2)

Head and neck injuries were primarily lacerations (557) and contusions or abrasions (237)

Injury to the extremities and trunk included mostly fractures contusions or abrasions and strains or sprains (upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 of preschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Reported by Div of Injury Epidemiology and Control Center for Environmental Health and Injury Control CDC

Injury to the extremities and trunk included

Mostly fracturesContusions or abrasions and strains or sprains

(Upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 ofpreschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Each year in the United States an estimated one in six residents requires medical treatment for an injury and an estimated one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury

This report summarizes national data on fatal and nonfatal injuries in the United States for 2001 by age sex mechanism intent and type of injury and other selected characteristics Reporting Period January--December 2001

For nonfatal injuries the majority of injured persons were treated in hospital EDs for

bull Lacerations (258) bull Strainssprains (202) bull Contusionsabrasions (183) bull Headneck region (295) majority bull Extremities (479)

Overall 55 of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care

Management

Quick and Dirty AssessmentABCrsquoSC-SPINENeurologicDeformities -PulsesWhen to call for helpCall parentsWhatrsquos in the Bag

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

Lacerations (385) contusions or abrasions (268) fractures (168) strains or sprains (44) and concussions (17) were most commonly reported (Table 2)

Head and neck injuries were primarily lacerations (557) and contusions or abrasions (237)

Injury to the extremities and trunk included mostly fractures contusions or abrasions and strains or sprains (upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 of preschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Reported by Div of Injury Epidemiology and Control Center for Environmental Health and Injury Control CDC

Injury to the extremities and trunk included

Mostly fracturesContusions or abrasions and strains or sprains

(Upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 ofpreschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Each year in the United States an estimated one in six residents requires medical treatment for an injury and an estimated one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury

This report summarizes national data on fatal and nonfatal injuries in the United States for 2001 by age sex mechanism intent and type of injury and other selected characteristics Reporting Period January--December 2001

For nonfatal injuries the majority of injured persons were treated in hospital EDs for

bull Lacerations (258) bull Strainssprains (202) bull Contusionsabrasions (183) bull Headneck region (295) majority bull Extremities (479)

Overall 55 of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care

Management

Quick and Dirty AssessmentABCrsquoSC-SPINENeurologicDeformities -PulsesWhen to call for helpCall parentsWhatrsquos in the Bag

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

Injury to the extremities and trunk included

Mostly fracturesContusions or abrasions and strains or sprains

(Upper extremity--624 222 and 122 lower extremity--314 422 and 154 trunk--277 512 and 92 respectively)

Approximately 53 ofpreschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Each year in the United States an estimated one in six residents requires medical treatment for an injury and an estimated one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury

This report summarizes national data on fatal and nonfatal injuries in the United States for 2001 by age sex mechanism intent and type of injury and other selected characteristics Reporting Period January--December 2001

For nonfatal injuries the majority of injured persons were treated in hospital EDs for

bull Lacerations (258) bull Strainssprains (202) bull Contusionsabrasions (183) bull Headneck region (295) majority bull Extremities (479)

Overall 55 of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care

Management

Quick and Dirty AssessmentABCrsquoSC-SPINENeurologicDeformities -PulsesWhen to call for helpCall parentsWhatrsquos in the Bag

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

Approximately 53 ofpreschool-aged children treated in emergency rooms for playground-related injuries required hospitalization

Each year in the United States an estimated one in six residents requires medical treatment for an injury and an estimated one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury

This report summarizes national data on fatal and nonfatal injuries in the United States for 2001 by age sex mechanism intent and type of injury and other selected characteristics Reporting Period January--December 2001

For nonfatal injuries the majority of injured persons were treated in hospital EDs for

bull Lacerations (258) bull Strainssprains (202) bull Contusionsabrasions (183) bull Headneck region (295) majority bull Extremities (479)

Overall 55 of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care

Management

Quick and Dirty AssessmentABCrsquoSC-SPINENeurologicDeformities -PulsesWhen to call for helpCall parentsWhatrsquos in the Bag

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

Each year in the United States an estimated one in six residents requires medical treatment for an injury and an estimated one in 10 residents visits a hospital emergency department (ED) for treatment of a nonfatal injury

This report summarizes national data on fatal and nonfatal injuries in the United States for 2001 by age sex mechanism intent and type of injury and other selected characteristics Reporting Period January--December 2001

For nonfatal injuries the majority of injured persons were treated in hospital EDs for

bull Lacerations (258) bull Strainssprains (202) bull Contusionsabrasions (183) bull Headneck region (295) majority bull Extremities (479)

Overall 55 of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care

Management

Quick and Dirty AssessmentABCrsquoSC-SPINENeurologicDeformities -PulsesWhen to call for helpCall parentsWhatrsquos in the Bag

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

For nonfatal injuries the majority of injured persons were treated in hospital EDs for

bull Lacerations (258) bull Strainssprains (202) bull Contusionsabrasions (183) bull Headneck region (295) majority bull Extremities (479)

Overall 55 of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care

Management

Quick and Dirty AssessmentABCrsquoSC-SPINENeurologicDeformities -PulsesWhen to call for helpCall parentsWhatrsquos in the Bag

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

Overall 55 of those treated for nonfatal injuries in hospital EDs were hospitalized or transferred to another facility for specialized care

Management

Quick and Dirty AssessmentABCrsquoSC-SPINENeurologicDeformities -PulsesWhen to call for helpCall parentsWhatrsquos in the Bag

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

Management

Quick and Dirty AssessmentABCrsquoSC-SPINENeurologicDeformities -PulsesWhen to call for helpCall parentsWhatrsquos in the Bag

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

HeadSpinal Cord Trauma

SYSTEMATIC ASSESSMENTBegin the 5 components of assessment performing interventions AS YOU GOStabilize c-spinemdashDO NOT move studentKEY ASSESSMENT POINTS FOR HEADSPINAL CORD TRAUMA1048707 Mental statusneurologic assessment1048707 Events leading up to injury1048707 Mechanism of injury1048707 Assessment for visual disturbances

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

Cervical Spine

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

C-spineEMS

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

History- Mechanism of Injury

bullInspection skin- puncture laceration Bleeding venous vs arteriole Deformity ecchymosis erythema crush injuries amputationPalpation Tenderness Crepitus Pulses Capillary refill perfusion Sensation

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

Laceration Management LacerationsAbrasions SYSTEMATIC ASSESSMENT Begin the 5 components of assessment

(see reverse) performing interventions AS YOU GO

KEY ASSESSMENT POINTS FOR LACERATIONS AND ABRASIONS

1048707 Inspection of wound 1048707 Neurovascular assessment distal to

injury 1048707 Pain pulse pallor paresthesia

paralysis (5 Ps mnemonic) 1048707 Capillary refill 1048707 Edema 1048707 Skin temperature

TRIAGE CATEGORYAPPROPRIATE INTERVENTIONS

Determine triage category and activate EMS AS SOON AS the need becomes apparent

EMERGENT 1048707 Absent distal pulses 1048707 Significant blood loss 1048707 Crush injury 1048707 Amputation (see Trauma protocol) 1048707 Penetrating wound 1048707 Capillary refill exceeds 2 sec 1048707 Altered LOC 1048707 SS of respiratory distress INTERVENTIONS 1048707 Support ABCs 1048707 Activate EMS 1048707 Control hemorrhage 1048707 Elevateimmobilize extremity 1048707 Directlycontinuously observe student 1048707 Contact parentguardian 1048707 Notify school administrator 1048707 Follow up

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

Wounds URGENT 1048707 Stable vital signs 1048707 Pulses present distal to injury 1048707 Significantly contaminated lacerations 1048707 Facial lacerations 1048707 Puncture wounds of foot 1048707 Wounds requiring sutures 1048707 Controllable bleeding INTERVENTIONS 1048707 Support ABCs 1048707 Determine need for EMS 1048707 Control bleeding with direct pressure 1048707 Observe student closely 1048707 Contact parentguardian to transport student to medical care or home 1048707 Follow up

NONURGENT 1048707 Stable vital signs 1048707 Superficial abrasion scrape or wound 1048707 Small splinter or foreign body INTERVENTIONS 1048707 Remove splinter 1048707 Cleanse wounds using aseptic technique 1048707 Bandage wounds 1048707 Observe student 1048707 Contact parentguardian 1048707 Return student to class or send home as indicated 1048707 Follow up

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

WOUND CARE A General wound

careaseptic cleansing Clean wounds thoroughly with

soap Rub abrasions gently with 4x4

gauze to remove debris and crusts

1048707 Rinse copiously with water 1048707 Bandage abrasions loosely

using nonadherent gauze to allow air circulation

1048707 Apply butterfly bandage to lacerations after bleeding has been controlled Steri-strips

Due to high risk of infection all deep puncture wounds of the foot must be

referred to a physician

DIRECT PRESSURE CONTROL THE BLEEDING ARTERIAL PRESSURE CRUSH INJURIES AMPUTATIONS-NOTED TIME TORNIQUET INDICATIONS COMPRESSION DRESSINGS TYPE OF SKIN WOUNDS

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

PRICE PRINCIPLEProtection- immobilization from further injuryRest- provide comfort decrease painICE- to the affected area 20-30 minutes 4-6

sessionsCompression-decrease bleeding and swellingElevation- remember swelling gravity

dependant

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS

Indications Angulation with unimpaired circulation 1048707 Immobilize as presented 1048707 Do not move extremity Angulation with ABSENT distal pulse cyanosis 1048707 Return extremity to proper

physiologic AreaInjury Treatment Upper extremity 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization is

indicated Clavicular injurydislocation 1048707 Apply

slingtriangular bandage 1048707 Swathe if additional immobilization

on 1048707 Apply gentle traction until pulse is

restored 1048707 Splint or immobilize area including

joints proximal and distal to injury 1048707 Reassess pulses every 5ndash10 minutes

SYSTEMATIC ASSESSMENT PEDIATRIC VITAL SIGNS BY AGE

Perform interventions AS YOU GO Determine triageactivate EMS at EARLIEST INDICATION of need Scene safety assessment 1048707 Call for assistance as indicated Across-the-room assessment Use Pediatric Assessment Triangle (PAT) 1048707 Appearance 1048707 Breathing 1048707 Circulation Initial assessment 1048707 Standard precautions 1048707 C-spine stabilization 1048707 Airway 1048707 Breathing 1048707 Circulation 1048707 Disabilitya 1048707 Exposure Historypain assessment 1048707 SAMPLE history 1048707 PQRSTother pain assessment Focused physical examination 1048707 Vital signs temperature weight blood glucose 1048707 Inspect 1048707 auscultate 1048707 palpate Triage 1048707 Emergent 1048707 Urgent 1048707 Nonurgent A Disability Assessment 1048707 Assess responsiveness (AVPU) A Alert V Responds to Verbal stimulus P Responds to Painful stimulus U Unresponsive 1048707 Assess pupils 1048707 Assess for transient paresthesi

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

FracturesKey to understand the mechanism of InjuryClosed vs OpenClosed- the skin is sealed or intactOpen- break in the skin puncture vs laceration type of bleeding controlling bleeding local vs Arterial pressurePulsesNeurologicShock

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

Applying a Sling SLING AND SWATHE IMMOBILIZATION Place the arm across the chest and position as shown Bring the bandage over the arm and behind the neck Adjust the length as necessary and tie the ends The arm should be well supported relieving pressure on the shoulder Place the knot so that it lies over the shoulder rather than against the cervical spine Placing a pad under the knot will enhance comfort Secure the sling at the elbow with a safety pin or knot creating a pocket in which the elbow rests securely Reassess neurovascular integrity If further SET THE HAND HIGH LIKE THE PLEDGE

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

Sprains and StrainsSprains are Injuries to the Ligament of a JointStrains are Injuries to the Muscles and

tendons Assessment ROM weight bearing statusManagement PRICE Treat sprains like

fracturesParent notificationWhat Next

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

SplintingImmobilize in position of injuryUnless there is vascular compromise- apply

straight line traction to reduce the fracture and note the time

Immobilize the joint above and below the fracture

Pad the area wellApply the splintPack in ICEElevation

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

What is in the BagAnd

Is it Ready to Go

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

Contents Bandaids ndash handful of large and small put in Ziploc bag Brown bag ndash lunch size BP cuff and stethoscope CPR Shield Digital thermometer TURKEY BASTER- Suction Epi-pen Eye wash Gauze ndash 4x4 in ziploc bag ABD Pads Kerlix roll frac12 dozen

Triangle Bandages Gloves Glucose gel tablets (if you have a diabetic student) Glucometer Instant Cold Pack Penlight School Nurse to EMSHospital Transfer Sheet form and

Pen Scissors TRAMA Tape 2 inch ConformCoban Prewrap SAM SPLINT-2 Space blanket Radio Cell AED

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

Emergency Orange Bag ndashMass Casualty EventsContentsAce bandage CobanAmbu bags ndash pedi and adultBiohazard bagBottle of WaterEye PadGauze and Kerlix TrianglePersonal protection gownSchool Nurse to EMSHospital Transfer Sheet forms ndash a fewSling and SplintTapeThermal reflecting blanketIV TherapyAED

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

SplintingAnything Can be used as a splintSAM Pillow Newspaper Tongue Depressor

VacuumImmobilize the joint above and below Pad the areaApply SlingCrutches Walker Wheel ChairICE

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

Open fracture CareYou Tube videohttpswwwyoutubecomwatchv=IADngkps

jKoAssess the Type of woundNote Vascular status areas of contaminationApply dressing preferably Betadine soakedImmobilized the Fracture

ORTHOPAEDIC URGENT CARESave time and moneySame as the Training Room In the sports worldOne Stop shopGive parents the option saving time from lost

wages95 injuries do not need to be seen in the ER

and are rarely admittedSave a step with out the hassle of the Er Ends up Ortho 10 days laterWalk in Orthopaedic care

Thank You

• Changing the Culture to The Emergency Room
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Slide 13
• Slide 14
• Slide 15
• Slide 16
• Initial ER Visit
• Slide 18
• Slide 19
• Slide 20
• School-Related Injuries Injury is the most common health problem treated by school health personnel
• Slide 22
• Slide 23
• Slide 24
• Slide 25
• No national reporting system for school-associated injuries or violence exists
• Injury rates
• Slide 28
• Systems Approach
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Management
• Slide 45
• Slide 46
• Cervical Spine
• C-spine EMS
• Evaluation of Injuries
• Slide 50
• Slide 51
• Laceration Management
• Slide 53
• Wounds
• WOUND CARE
• Slide 56
• PRICE PRINCIPLE
• Slide 58
• IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS
• Fractures
• Applying a Sling
• Sprains and Strains
• Splinting
• What is in the Bag And Is it Ready to Go
• RUN KIT TO TAKE TO CLASSROOM EVENT
• Emergency Orange Bag Mass Casualty
• Splinting
• Slide 68
• Slide 69
• Open fracture Care
• Slide 71
• ORTHOPAEDIC URGENT CARE
• Slide 73
• Slide 74
• Slide 75

Thank You

• Changing the Culture to The Emergency Room
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Slide 13
• Slide 14
• Slide 15
• Slide 16
• Initial ER Visit
• Slide 18
• Slide 19
• Slide 20
• School-Related Injuries Injury is the most common health problem treated by school health personnel
• Slide 22
• Slide 23
• Slide 24
• Slide 25
• No national reporting system for school-associated injuries or violence exists
• Injury rates
• Slide 28
• Systems Approach
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Management
• Slide 45
• Slide 46
• Cervical Spine
• C-spine EMS
• Evaluation of Injuries
• Slide 50
• Slide 51
• Laceration Management
• Slide 53
• Wounds
• WOUND CARE
• Slide 56
• PRICE PRINCIPLE
• Slide 58
• IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS
• Fractures
• Applying a Sling
• Sprains and Strains
• Splinting
• What is in the Bag And Is it Ready to Go
• RUN KIT TO TAKE TO CLASSROOM EVENT
• Emergency Orange Bag Mass Casualty
• Splinting
• Slide 68
• Slide 69
• Open fracture Care
• Slide 71
• ORTHOPAEDIC URGENT CARE
• Slide 73
• Slide 74
• Slide 75

• Changing the Culture to The Emergency Room
• Slide 2
• Slide 3
• Slide 4
• Slide 5
• Slide 6
• Slide 7
• Slide 9
• Slide 10
• Slide 11
• Slide 12
• Slide 13
• Slide 14
• Slide 15
• Slide 16
• Initial ER Visit
• Slide 18
• Slide 19
• Slide 20
• School-Related Injuries Injury is the most common health problem treated by school health personnel
• Slide 22
• Slide 23
• Slide 24
• Slide 25
• No national reporting system for school-associated injuries or violence exists
• Injury rates
• Slide 28
• Systems Approach
• Slide 30
• Slide 31
• Slide 32
• Slide 33
• Slide 34
• Slide 35
• Slide 36
• Slide 37
• Slide 38
• Slide 39
• Slide 40
• Slide 41
• Slide 42
• Slide 43
• Management
• Slide 45
• Slide 46
• Cervical Spine
• C-spine EMS
• Evaluation of Injuries
• Slide 50
• Slide 51
• Laceration Management
• Slide 53
• Wounds
• WOUND CARE
• Slide 56
• PRICE PRINCIPLE
• Slide 58
• IMMOBILIZATIONPOSITIONING OF FRACTURES AND DISLOCATIONS
• Fractures
• Applying a Sling
• Sprains and Strains
• Splinting
• What is in the Bag And Is it Ready to Go
• RUN KIT TO TAKE TO CLASSROOM EVENT
• Emergency Orange Bag Mass Casualty
• Splinting
• Slide 68
• Slide 69
• Open fracture Care
• Slide 71
• ORTHOPAEDIC URGENT CARE
• Slide 73
• Slide 74
• Slide 75