Muscular/Neuro/Trauma
A&P:
○ Cranial bones are not fused
○ Sutures and fontanels so babies head can grow
○ Spine mobile, watch for shaken baby
○ Skeleton not fully ossified, leaving them to be more flexible
○ Myelination incomplete, needed for potty training, complete by 2
○ Growth plates, weakest part of bone, where the bone grows
Level of Consciousness: Earliest indicator if patient is getting better or worse
Peds CPR:
○ Single rescuer: 30:2 compression to breath ratio
○ Two rescuers: 15:2 compression to breath ratio
Glasgow Coma Scale (GCS):
○ Lower the score worse it is
○ Helps you tell what kind of patient you are getting
○ At 2, patient may be able to talk
○ Ambulance should be giving a standard score
Assessment of Neuro Status:
○ Nystagmus - (movements of eye) is NOT NORMAL
○ Sunset Appearance - Colored part of eye is down and white above, which can mean ICP
increase
○ Dolls eye - move their head to the right and their eyes go to the left (ABNORMAL)
○ REPORT SUDDEN PRESENCE OF FIXED AND DILATED PUPILS CAN MEAN INCREASE
ICP
○ If you do not report fixed and dilated pupils you can have brain stem herniation
Early Signs of increased ICP:
○ Headache (make sure age is appropriate)
○ Blurred vision, dizzy, double vision, changes in LOC
○ Infants: bulging fontanel, wide sutures, head circumf, high pitched cry, sunset eyes
Late signs of increased ICP:
○ Lower LOC
○ Bradycardia
○ Irregular respirations
○ Cheyne-stokes respirations (death rattle), apnea to rapid respirations
○ Decorticate/flexion - patient is positioned into the core, rigid, tight
○ Decerebrate/Extension - patient position is rotated outwards, damage to midbrain
, Skull Fractures:
○ Arteries lie underneath the skull and they can shear and bleeding, increasing ICP
○ Linear: straight line
○ Depressed: pushed inward, putting pressure on the brain and increasing ICP
- Pressure needs to be relieved
○ Basilar: base of the skull
- Racoon eyes (periorbital ecchymosis)
- Bruising behind ears
- Leaking CSF in ears or nose, TEST FOR GLUCOSE, MAKE A HALO SIGN ON
GAUZE
- Risk for meningitis
- NO NGT! If you insert nasally it can go into the soft tissue of the brain
Hemorrhaging:
○ Causes increased ICP
○ Subdural (Venous Bleed):
- Bleeding slower
- Birth trauma
○ Epidural (Arterial Bleed):
- Faster bleed which increase ICP rapidly
- Trauma or abuse
- Brain compression can occur rapidly
Management of ICP:
○ Steroids to help decrease inflammation
○ Mannitol (diuretic), analgesics, NO NARCOTICS, keep patient calm, cluster care
○ Burr holds, percutaneous aspiration, drains
○ Craniotomy
○ Head of bed elevated to increase draining
○ Minimize suctioning
○ Avoid coughing and blowing nose which increases ICP
○ Maintain 02 stats > 95
Seizures:
○ Uncontrolled electrical discharge
○ Ask parents what they saw
○ Atonic Seizures: without tone, SAFETY IS A BIG CONCERN
○ Febrile seizures are most common in kids, not as concerning, after 5 dont see it much
○ Epilepsy: two or more unprovoked seizures more than 24 hours apart
- Seizures are occurring for no reason (no trauma, no fever)
A&P:
○ Cranial bones are not fused
○ Sutures and fontanels so babies head can grow
○ Spine mobile, watch for shaken baby
○ Skeleton not fully ossified, leaving them to be more flexible
○ Myelination incomplete, needed for potty training, complete by 2
○ Growth plates, weakest part of bone, where the bone grows
Level of Consciousness: Earliest indicator if patient is getting better or worse
Peds CPR:
○ Single rescuer: 30:2 compression to breath ratio
○ Two rescuers: 15:2 compression to breath ratio
Glasgow Coma Scale (GCS):
○ Lower the score worse it is
○ Helps you tell what kind of patient you are getting
○ At 2, patient may be able to talk
○ Ambulance should be giving a standard score
Assessment of Neuro Status:
○ Nystagmus - (movements of eye) is NOT NORMAL
○ Sunset Appearance - Colored part of eye is down and white above, which can mean ICP
increase
○ Dolls eye - move their head to the right and their eyes go to the left (ABNORMAL)
○ REPORT SUDDEN PRESENCE OF FIXED AND DILATED PUPILS CAN MEAN INCREASE
ICP
○ If you do not report fixed and dilated pupils you can have brain stem herniation
Early Signs of increased ICP:
○ Headache (make sure age is appropriate)
○ Blurred vision, dizzy, double vision, changes in LOC
○ Infants: bulging fontanel, wide sutures, head circumf, high pitched cry, sunset eyes
Late signs of increased ICP:
○ Lower LOC
○ Bradycardia
○ Irregular respirations
○ Cheyne-stokes respirations (death rattle), apnea to rapid respirations
○ Decorticate/flexion - patient is positioned into the core, rigid, tight
○ Decerebrate/Extension - patient position is rotated outwards, damage to midbrain
, Skull Fractures:
○ Arteries lie underneath the skull and they can shear and bleeding, increasing ICP
○ Linear: straight line
○ Depressed: pushed inward, putting pressure on the brain and increasing ICP
- Pressure needs to be relieved
○ Basilar: base of the skull
- Racoon eyes (periorbital ecchymosis)
- Bruising behind ears
- Leaking CSF in ears or nose, TEST FOR GLUCOSE, MAKE A HALO SIGN ON
GAUZE
- Risk for meningitis
- NO NGT! If you insert nasally it can go into the soft tissue of the brain
Hemorrhaging:
○ Causes increased ICP
○ Subdural (Venous Bleed):
- Bleeding slower
- Birth trauma
○ Epidural (Arterial Bleed):
- Faster bleed which increase ICP rapidly
- Trauma or abuse
- Brain compression can occur rapidly
Management of ICP:
○ Steroids to help decrease inflammation
○ Mannitol (diuretic), analgesics, NO NARCOTICS, keep patient calm, cluster care
○ Burr holds, percutaneous aspiration, drains
○ Craniotomy
○ Head of bed elevated to increase draining
○ Minimize suctioning
○ Avoid coughing and blowing nose which increases ICP
○ Maintain 02 stats > 95
Seizures:
○ Uncontrolled electrical discharge
○ Ask parents what they saw
○ Atonic Seizures: without tone, SAFETY IS A BIG CONCERN
○ Febrile seizures are most common in kids, not as concerning, after 5 dont see it much
○ Epilepsy: two or more unprovoked seizures more than 24 hours apart
- Seizures are occurring for no reason (no trauma, no fever)
