Emergency Splinting

and Trauma First Aid

Objectives

Review the most common injuries in children •

Discuss what to ask, examine and do for each •
process
Suggest who needs further care and who can •
return to class
Common Injuries

Bumps and Bruises • Oral Trauma •

Scrapes • Nose Bleeds •
Sprains • Lacerations •
Strains • Head Injuries •
Fractures • Overheating •
Bumps and Bruises
Bobby Bobo, a 5 y/o boy, fell down •
in class while chasing the teacher’s
lost hamster. He hit his right thigh
on the corner of a desk and now
complains of pain and swelling to
the leg. By the time he arrives his
right thigh is tight from the swelling.
He says he has “Christmas Disease.”
Bumps and Bruises
What to ask?
What happened and when? •
Abuse vs. accidental ▫
Inconsistent mechanism, frequent bruising 
Abnormal locations 
Abnormal patterns 
No trauma? Think mass, infection, clotting ▫
d.o.
Anything else hurt? •
PMHx? (Aspirin, coumadin, bleeding…) •
Bumps and Bruises

What to examine?
Entire body •
Look for patterns ▫
Suspicious locations ▫
Trunk 
Face 
Scalp 
Multiple stages of bruises? ▫
Bone pain? •
Nonaccidental Trauma

Bite
Bumps and Bruises

What to do?
Cold pack •
Tylenol •
Most need nothing •
CPS? •
Law is “if suspicious…report.” ▫
You are protected ▫
Confidential ▫
Texas Law

Child abuse and neglect are against the law in •

Texas, and so is failure to report it.
If you suspect a child has been abused or •
mistreated, you are required to report it to the
Texas Department of Family and Protective
Services or to a law enforcement agency.
You are required to make a report within 48 •
hours of the time you suspected the child has
been or may be abused or neglected.
Abuse Hotline 1-800-252-5400
Bumps and Bruises

Where to send them?

Back to class •
Most ▫
Not rapidly expanding ▫
Not suspicious ▫
Doctor •
Large/deep, multiple, expanding ▫
Uncertain of etiology (mass/infection/abuse) ▫
Scrapes

A 9 y/o girl, Terri •

Tawmboi, is brought to
you after she got “a huge
raspberry” playing
kickball at recess. Her
right knee is bleeding and
covered with grass and
dirt.
Scrapes

What to ask?
What happened? •
What did you fall on? •
Hard versus soft ▫
Loose objects = foreign bodies ▫
Able to bear weight? •
Anything else hurt? •
Vaccinations (Tetanus)? •
Scrapes

What to examine?
Wound •
Deep vs. superficial ▫
Clean vs. contaminated ▫
If old, infected? Impetigo  ▫
Range of motion •
Weight bearing •
Scrapes

What to do?
Gently clean •
Saline and gauze ▫
Clean wet washcloth ▫
Running tap water ▫
Remove debris •
Antibiotic ointment •
Bandage •
Scrapes

Where to send them?

Back to class almost always •
Doctor •
Retained foreign body ▫
Restricted use of extremity ▫
Concern for joint penetration ▫
Sprains

Trey Studmuffin, your transfer, red- •

shirt, freshman, power-forward,
“came down wrong” on a teammate's
shoe during tryouts. He hops into the
office on one foot asking you to “tape
me up!”
Sprains

What to ask?
What happened? •
Mechanism ▫
Twist or turn 
Blunt trauma 
“Something popped” or “gave way” 
Could you walk on it (even with a limp)? ▫
Old injury, ask if fever, chills, medical hx. •
Sprains
What to examine?
Entire involved extremity •
Pain ▫
Swelling ▫
Bruising ▫
Redness ▫
Warmth ▫
ROM, gait ▫
Other joints •
Ankle Sprain
Knee Sprain
Septic Joint
Sprains
What to do?
“pRICEmmms”
Protect the joint = crutches, slings, tape… •
Rest •
Ice •
Compression •
Elevation •
Medication, modality (PT), motion (keep •
loose)
Strength •
Sprains

Where to send them?

Back to class •
Most ▫
Pain under control ▫
Doctor •
Suspect fracture, infection, systemic disease ▫
Not weight bearing ▫
Pain poorly controlled ▫
Strains
Coach Oldskool, your legendary, and older •
than he wants to admit, football coach crawls
into your clinic complaining, “I popped my
back showing my History Class how to chop
block on a double reverse.”
Strains

What to ask?
What happened? •
Sudden jerking movements? ▫
Lifting? ▫
Sprinting? ▫
Jumping? ▫
Did you feel a pop? Tear? •
Numbness/tingling/weakness? •
Sprain Mechanisms
Strains

What to examine?
Where it hurts •
Spasm ▫
Swelling ▫
Bruising ▫
Joints above and below •
Neuorologic function (back injuries) •
Gait •
Strains

What to do?
Similar to strains •
Massage/stretch if spasm •
Strains

Where to send them?

Back to class •
Most ▫
Pain controlled ▫
Doctor •
Not bearing weight ▫
Severe pain ▫
Any numbness/tingling/weakness ▫
Fractures
Morgan Fleahopper, the 85 lb. •
head cheerleader, and the one
always at the top of all those
stacks of girls, fell off the
infamous “Pyramid of Victory”
at the 7 a.m. walk through. Her
left elbow is pointing the wrong
way but her make-up remains
flawless.
Fractures
What to ask?
Describe the injury? •
Fall vs. blunt trauma vs. twist ▫
How did you land? ▫
Where is the worst pain (use one finger)? ▫
Could you walk right afterward? ▫
Anything else hurt? ▫
Neck pain/back pain if severe fracture(s)? •
Fractures
What to examine?
Point tenderness/deformity •
Open fracture •
Joint swelling •
Muscle spasms •
Function/sensation below fracture •
ROM/walk •
Neck/back if “distracting injury” •
Fractures
What to do?
Stabilize = Splinting •
Joint above and below fracture ▫
Not too tight, use padding ▫
Not too loose, shouldn’t wiggle ▫
Don’t hide the extremity, not circumferential ▫
Pain control •
Ice ▫
Medications ▫
Ankle Pillow Splint
Lower Leg Splint
Long Leg Splint
Finger Splints
Wrist (Volar) Splint
Upper Arm Splint
Cervical Spine Splints
Fractures

Where to send them?

Doctor •
Most ▫
EMS if severe, neurovascular changes, spine ▫
Back to class •
Broken hearts ▫
Shattered dreams ▫
Crushed morale ▫
Oral Trauma

Dirk Noteeski catches an •

elbow during a
scrimmage and comes in
grinning, with his two
front teeth in his hand.
His mouth is full of
blood.
Oral Trauma

What to ask?
What happened? •
Tooth/jaw/lip/tongue hurt? ▫
What hit you? (BAD if it is another person) ▫
How long ago? ▫
Permanent teeth? ▫
Where are the teeth? •
Have a dentist? •
Oral Trauma

What to examine?
Teeth •
Avulsed (knocked out, loose) ▫
Fractured ▫
Chipped ▫
Intrusion ▫
Jaw/face: feel for “crunchy” sensation •
Mucosal/tongue injury •
Tooth Anatomy
Avulsed Teeth
Fractured Teeth
Intrusion
Tongue/Mucosal Trauma
Oral Trauma
What to do?
Teeth •
Avulsion ▫
Primary teeth 
Out, leave out 
Loose, straighten or is very loose remove 
Permanent teeth 
Out, leave out, wash gently, store in cold milk, saline, 
spit.
Loose, leave alone 
Fracture, keep fragment, store as above ▫
Oral Trauma

What to do?
Tongue •
Well approximated, nothing ▫
Bleeding  direct pressure with gauze ▫
Gaping need repair ▫
Mucosal •
Well approximated, nothing ▫
Gaping and vermillion border need repair ▫
Oral Trauma

Where to send them?

Dental injuries •
Dentist for most injuries ▫
Baby teeth may need nothing ▫
Tongue/Mucosa •
Most need nothing ▫
Doctor if gaping, severe bleeding, vermillion ▫
Nose Bleeds

Little 8 y/o Penny Piksalot is rushed to you with •

gushing blood from her left nare.
Nose Bleeds

What to ask?
How much blood, how long? •
What has been done to stop bleeding? •
Trauma? •
Blunt ▫
Picking ▫
Upper respiratory infection? Allergies? •
History of Bleeding? •
Nose Bleeds

What to examine?
Nose •
Fracture (usually at bridge) ▫
Active bleeding ▫
Which side? Always the same? 
Throat 
Neurologic •
Vision •
Nose Bleeds

What to do?
Pinch x 10-20 minutes (don’t peek) •
Don’t put head between legs •
Don’t blow nose •
Afrin if available •
No PICKING! •
Penny’s Father
Nose Bleeds
Where to send them?
Back to class •
Most if stops after 20 minutes ▫
No other injury ▫
Not dizzy, weak, pale ▫
Doctor •
Severe bleeding ▫
Bleeding disorder ▫
Other injuries ▫
Lacerations

Paris Marriott is back from the South of France •

for a little quality time with friends when she
crashes daddy’s SLK into a parked bus in the
Faculty Lot. She comes in screaming with a
1/8th cm “gash” to her right cheek. She’s suing
the bus driver and wants the school plastic
surgeon called “now!”
Lacerations

What to ask?
How did it happen? •
Sharp vs. blunt force? ▫
Fall, if so how high? ▫
Foreign body, dirty? ▫
Puncture? ▫
How long ago? ▫
Tetanus status •
Lacerations
What to examine?
Wound •
How wide? ▫
How deep? ▫
How long? ▫
Contaminated? ▫
Across nerves/tendons/vessels/galea? ▫
Head/spine injury? •
Fracture? •
Scalp Laceration
Forehead Laceration
Hand Laceration
Lacerations

What to do?
Stop bleeding •
Wear gloves ▫
Direct pressure ▫
1 gauze at a time ▫
Decide if repair needed •
No  wash, antibiotic ointment, bandage ▫
Yes  wash, cover with saline soaked gauze(s) ▫
Lacerations

Where to send them?

Doctor •
Most ▫
All if: ▫
Contaminated 
Persistent bleeding 
Across/near vital structures 
Associated with fracture 
Back to class if very superficial •
Head Injuries

Goofus McDoofus, the class •

clown, thought it would be
hilarious to hang upside down
from the goalposts at P.E.. He fell
10 feet and stuck the landing with
his noggin. You run to find him
“out cold” with a few hundred
people trying to wake him up.
Head Injuries
What to Ask?
What happened? • Symptoms •
Witnessed? ▫ Loss of consciousness? ▫
Fall vs. blunt trauma? ▫ Immediate/delayed? 
How far/hard? ▫ How long? 
Motor activity? 
What surface? ▫ Stiff 
How landed? ▫ Jerking 
Limp 
Vomiting? ▫
Immediate vs. delayed? 
How many times? 
Weak/numb/AMS? ▫
Head Injuries
What to Ask?
Headache? •
Severity ▫
Worsening ▫
Neck/back injury •
Other pain? •
H/o seizures, fainting? •
Medications •
Head Injuries

What to examine?
Head •
Contusions, feel for the bottom ▫
Step off (depressed skull fracture) ▫
Lacerations ▫
Battle sign/Racoon eyes ▫
Spine (top to bottom) •
CNS/other injuries •
Depressed Skull Fracture
Battle Sign
Raccoon Eyes
Intracranial Bleeding
Epidural Hematoma Brain Contusion
Head Injuries

What to do? Where to go?

Assume spine injury •
Stabilize C-spine ▫
Keep child still, laying down ▫
EMS •
Loss of consciousness ▫
Persistant mental status changes ▫
Back to class if mild, asymptomatic after •
Overheating

Smoky Johnson is trying to •

get his weight down for his
big wrestling match on
Friday and is found “acting
funny” after running a few
laps during PE. It’s 102
degrees and he is wearing
two sweat suits and a wool
ski cap.
Overheating
What to ask?
What’s wrong? •
Heat rash small red bumps in hottest areas ▫
Heat cramps arms/legs/abdominal muscles ▫
Heat exhaustion Dizzy, nausea, vomiting, ▫
headaches, weakness, muscle pain, clammy.
Heat stroke Above except dry skin, confused (to ▫
coma), seizures, dry hot skin
How did it happen? •
Medications/drugs? •
Overheating

What to examine?
Take core temperature •
T 104 for Heat Stroke ▫
May be normal for others ▫
Mental status •
Skin •
Pulses •
Overheating
What to do?
Remove from •
heat
Rapidly cool •
Overheating

Where to send them?

Heat rash  back to class •
Heat cramps  usually back to class •
Heat exhaustion  Doctor, EMS if severe •
Heat stroke  EMS, life threatening •
Thank You!

You ask me why I do not write

something.... I think one's feelings
waste themselves in words, they ought
all to be distilled into actions and into
actions which bring results.
•Florence Nightengale