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
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Common Injuries
Bumps and Bruises
Scrapes
Sprains
Strains
Fractures
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Oral Trauma
Nose Bleeds
Lacerations
Head Injuries
Overheating
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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
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No trauma? Think mass, infection, clotting d.o.
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Anything else hurt?
PMHx? (Aspirin, coumadin, bleeding…)
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Bumps and Bruises
What to examine?
Entire body
Look for patterns ▫
Suspicious locations
Trunk
Face
Scalp
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Multiple stages of bruises?
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Bone pain?
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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 ▫
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Texas Law
Child abuse and neglect are against the law in
Texas, and so is failure to report it.
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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.
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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.
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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) ▫
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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.
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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)?
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Scrapes
What to examine?
Wound
Deep vs. superficial ▫
Clean vs. contaminated
If old, infected? Impetigo 
Range of motion
Weight bearing
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Scrapes
What to do?
Gently clean
Saline and gauze ▫
Clean wet washcloth
Running tap water
Remove debris
Antibiotic ointment
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Bandage
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Scrapes
Where to send them?
Back to class almost always
Doctor
Retained foreign body
Restricted use of extremity ▫
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Concern for joint penetration ▫
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Sprains
Trey Studmuffin, your transfer, redshirt, 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”
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Could you walk on it (even with a limp)? ▫
Old injury, ask if fever, chills, medical hx.
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Sprains
What to examine?
Entire involved extremity
Pain ▫
Swelling
Bruising
Redness
Warmth
ROM, gait ▫
Other joints
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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
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Sprains
Where to send them?
Back to class
Most ▫
Pain under control ▫
Doctor
Suspect fracture, infection, systemic disease
Not weight bearing
Pain poorly controlled
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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.”
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Strains
What to ask?
What happened?
Sudden jerking movements?
▫
Lifting?
Sprinting?
Jumping?
Did you feel a pop? Tear?
Numbness/tingling/weakness?
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Sprain Mechanisms

Strains
What to examine?
Where it hurts
Spasm ▫
Swelling
Bruising
Joints above and below
Neuorologic function (back injuries)
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▫
Gait
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Strains
What to do?
Similar to strains
Massage/stretch if spasm
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Strains
Where to send them?
Back to class
Most ▫
Pain controlled ▫
Doctor
Not bearing weight
Severe pain
Any numbness/tingling/weakness
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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.
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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?
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Neck pain/back pain if severe fracture(s)?
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Fractures
What to examine?
Point tenderness/deformity
Open fracture
Joint swelling
Muscle spasms
Function/sensation below fracture
ROM/walk
Neck/back if “distracting injury”
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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
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Pain control
Ice ▫
Medications ▫
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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
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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?
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Oral Trauma
What to examine?
Teeth
Avulsed (knocked out, loose) ▫
Fractured
Chipped
Intrusion
Jaw/face: feel for “crunchy” sensation
Mucosal/tongue injury
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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 
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Fracture, keep fragment, store as above ▫
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Oral Trauma
What to do?
Tongue
Well approximated, nothing ▫
Bleeding  direct pressure with gauze
Gaping need repair ▫
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Mucosal
Well approximated, nothing
Gaping and vermillion border need repair ▫
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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 ▫
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Nose Bleeds
Little 8 y/o Penny Piksalot is rushed to you with gushing blood from her left nare.
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Nose Bleeds
What to ask?
How much blood, how long?
What has been done to stop bleeding?
Trauma?
Blunt
Picking ▫
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Upper respiratory infection? Allergies?
History of Bleeding?
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Nose Bleeds
What to examine?
Nose
Fracture (usually at bridge) ▫
Active bleeding
Which side? Always the same?
Throat 
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Neurologic
Vision
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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!
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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 ▫
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Doctor
Severe bleeding
Bleeding disorder ▫
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Other injuries ▫
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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
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Faculty Lot. She comes in screaming with a
1/8 th 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
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Lacerations
What to examine?
Wound
How wide?
▫
How deep?
How long?
Contaminated?
Across nerves/tendons/vessels/galea?
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Head/spine injury?
Fracture?
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Scalp Laceration

Forehead Laceration

Hand Laceration

Lacerations
What to do?
Stop bleeding
Wear gloves ▫
Direct pressure
1 gauze at a time ▫
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Decide if repair needed
No  wash, antibiotic ointment, bandage
Yes  wash, cover with saline soaked gauze(s) ▫
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Lacerations
Where to send them?
Doctor
Most ▫
All if:
Contaminated
Persistent bleeding
Across/near vital structures
Associated with fracture 
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Back to class if very superficial
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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?
Witnessed?
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Fall vs. blunt trauma?
How far/hard?
What surface?
How landed?
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• Symptoms
Loss of consciousness?
Immediate/delayed?
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How long?
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Motor activity?
Stiff
Jerking
Limp 
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Vomiting?
Immediate vs. delayed?
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How many times?
Weak/numb/AMS?
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Head Injuries
What to Ask?
Headache?
Severity ▫
Worsening ▫
Neck/back injury
Other pain?
H/o seizures, fainting?
Medications
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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
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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 ▫
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Back to class if mild, asymptomatic after
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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.
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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
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How did it happen?
Medications/drugs?
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Overheating
What to examine?
Take core temperature
T 104 for Heat Stroke ▫
May be normal for others ▫
Mental status
Skin
Pulses
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Overheating
What to do?
Remove from heat
Rapidly cool
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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
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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