Understanding patterns of injury in Kenya: Analysis of a trauma registry data from a National Referral Hospital

Understanding patterns of injury in KenyaAnalysis of a trauma registry data from a NationalReferral Hospital

Botchey IM Jr, Hung YW, Bachani AM, Saidi H, Paruk F, Hyder AA.
Surgery. 2017 Apr 21. pii: S0039-6060(17)30158-7. doi: 10.1016/j.surg.2017.02.016. [Epub ahead of print]

Foreign Bodies in Kids

  • If there is an insect in the external auditory canal, kill it first. They will fight for their lives if you try to dismember or take them out.  “In the heat of battle, the patient can become terrorized by the noise and pain and the instrument that you are using is likely to damage the ear canal.”
  • Vegetable matter in the ear? Don’t irrigate it – the organic material will swell against the fixed structure, and cause more pain, make it much harder to extract, and may increase the risk of infection.
  • Beware of unilateral nasal discharge in a child – strongly consider retained foreign body
  • Children 1 year and up, conscious – Heimlich maneuver: stand behind patient with arms positioned under the patient’s axilla and encircling the chest. The thumb side of one fist should be placed on the abdomen below the xiphoid process. The other hand should be placed over the fist, and 5 upward-inward thrusts should be performed. This maneuver should be repeated if the airway remains obstructed.

 

Paediatric Resuscitation Guidelines

The pediatric assessment triangle, provides a valuable checklist that we should go through for every child we see in the ED to help us assess their risk of crashing. The pediatric assessment triangle is based solely on observing the child from the foot of the bed.

 

Dizziness…the good and the ugly…

The differential diagnosis of vertigo can be broken into peripheral and central causes. It is imperative the Emergency Physician consider central causes of vertigo.

 

Signs/ Symptoms Differentiating Peripheral and Central Vertigo

Peripheral Central
Onset Sudden or Insidious Sudden
Severity of Vertigo Intense Spinning Ill-defined, may be severe or less intense
Prodromal Dizziness Occurs in up to 25%, often single episode Occurs in up to 25%, recurrent episodes suggest TIA’s
Intolerant of head movements/Dix-Hallpike Maneuver Yes Varies, but often intolerant
Associated Nausea/Diaphoresis Frequent Variable, but often frequent
Auditory Symptoms Points to peripheral causes May be present
Proportionality of Symptoms Usually proportional Often disproportionate
Headache/Neck Pain Unusual More likely
CNS signs/symptoms Absent Usually present
Head Impulse Test Abnormal Often normal
Nystagmus Horizontal Vertical/direction-changing
HINTS Testing Negative Abnormal in at least 1 out of 3 tests