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Emergency Room
Nose Bleeds
Category: Nose Bleeds, Jul 20, 2011

56570098Nosebleeds occur frequently in children and have many causes. The most common cause is nose picking. Other causes include colds, allergies, sinusitis, and exposure to very dry air, especially in heated homes in winter. Nosebleeds are very common at high altitudes because of the dry, cold air.

When you suction your infant’s nose with a bulb aspirator (to help clear the nasal passages), a small amount of bleeding may occur.


preventPrevention

  • If the air in your home is too dry, use a humidifier and try to keep the humidity around 40 percent. Remember, if your house or bedroom has high humidity for prolonged periods, you will encourage the growth of molds and replication of house dust mites, which in turn may lead to allergies.
  • Use saltwater (saline) nose drops frequently while traveling. The dry air of the aircraft cabin and dusty air while traveling on country roads will lead to a dry and stuffy nose. Each person should have their own bottle of saline drops.
  • If your child has repeated nosebleeds, coat the lower part of the nasal septum (the part of the nose dividing each nostril) twice a day with a petroleum jelly (e.g., Vaseline).
  • Discourage nose picking.


treatmentTreatment

Have your child sit up, lean forward, and breathe through the mouth. Pinch the soft fleshy part of the nose tightly closed for about 10 minutes. (Hold a basin under the chin to catch any blood or mucus that drips through the mouth.) After the nosebleed has stopped, instruct your child not to pick his nose or to blow it too vigorously, otherwise the bleeding may restart.


medical-symbolWhen to Seek Medical Attention

  • If your child’s nose continues to bleed after applying pressure to the nose for 20 minutes. (If you do not have access to medical care and you have nasal decongestant nose drops such as Neosynephrine or oxymetazoline [Afrin], use these, as they constrict blood vessels  and  will often help to stop the nosebleed. You may need to use two or three times the recommended dose to stop the bleeding. Never use nasal decongestant drops or sprays for longer than five days.)
  • If your child has a foul-smelling or bloody discharge from one nostril for some days. This may be due to a foreign body up the nose.
  • If your child has a tendency to bleed in other areas as well—for example, from the gums or into the skin.
  • If your child gets recurrent nosebleeds despite using preventive measures.
Rabies
Category: Rabies, Jul 19, 2011

90862005Rabies and rabies prevention are still a significant public health issue in the United States. Rabies in humans fortunately is rare because of prophylactic measures after animal bites and because of control of rabies in domestic animals. It is a major medical issue in developing countries, with up to 100,000 human deaths worldwide annually.

In the United States, the animals that usually spread rabies are raccoons, skunks, foxes, and bats. Raccoons are the number one cause. In developing countries the most frequent cause of rabies is dog bites.


preventPrevention

  • Immunize your pets against rabies.
  • Use caution around animals you do not know, even domestic ones.
  • Avoid physical contact with strays and wild animals, whether dead or alive.
  • Do not attempt to domesticate wild animals, especially raccoons.
  • Tightly secure garbage can lids and make them less accessible to prowling dogs, raccoons, and skunks.
  • If you have young children and you plan an extended stay in a country where rabies is common, consider getting them immunized against rabies.

Remember, in developing countries, dogs are the number one cause of rabies. Caution your children about petting dogs in third-world countries, especially in Asia. Domestic pets such as white rats, hamsters, and mice do not carry rabies. Squirrel bites would be very unlikely to lead to rabies. If there is any doubt, contact your doctor or local state public health authorities. Be especially wary of bats: your child does not have to be bitten by a bat to get rabies.

Rabies may be transmitted via bat urine or other bat secretions entering through mucous membranes such as the eye or mouth. If there is any doubt about your child’s exposure to a bat while sleeping, contact your doctor or local health authorities.


treatmentTreatment

Initial treatment of any animal bite includes extensive cleansing, as described in Chapter 55, followed by further wound care as necessary. Your child may also need tetanus prevention as well as antibiotics. Your doctor will then determine whether a course of rabies shots is necessary.


Note: If you are planning an extended stay in an area where there is a high incidence of rabies, consider immunizing your children against rabies before you depart. This may be important if you are planning a long stay in a lesser-developed country where rabies is common.

Mammal Bites
Category: Mammal Bites, Jul 19, 2011

c0027957tsBites not only cause immediate tissue damage but also carry the risk of infection and rabies. Human bites are the bites most likely to become infected, followed by cat bites and then dog bites. Cat bites may look very minor, but infected material is often injected deeply into the tissues.





treatmentTreatment

The most important treatment of any bite is vigorous cleaning of the wound as soon as possible. This is best done by holding the affected area under running water for at least 5 to 10 minutes. Contact your doctor for further treatment such as tetanus shots, rabies prevention, antibiotics, and/or suturing if needed. This will depend on the size and location of the bite and the likelihood of infection. For crush injuries, splinting and elevation of the affected extremity is recommended.



medical-symbolWhen to Seek Medical Attention

It is especially important to seek medical care for bites involving the face and puncture wounds of the hands and feet. If your child has been bitten by a wild animal or a domestic animal that you don’t know, rabies prophylaxis may be needed



INFECTION

Signs that the bite wound is infected include the following:

  • Increasing redness
  • Increasing swelling
  • Increasing pain
  • Pus discharging from the wound
  • Red streaks extending from the bite site toward the heart
  • Fever
Drowning
Category: Drowning, Jul 19, 2011

200223688-001Drowning is one of the most common causes of death in childhood in the United States. In some states it is the leading cause of death in childhood. On average, one child drowns every day in a backyard swimming pool. Drowning is also one of the more common causes of death while on vacation.

In the home setting, drowning may occur in the bathtub, the toilet, a bucket, a water barrel, a children’s play pool, or the backyard swimming pool. Drowning also frequently happens during water recreational activities such as sailing, canoeing, or swimming. Although people of any age can drown, there are two age groups in which drowning are more common.

The first is the toddler age group; toddlers can drown in the bathtub or in as little as 1 inch of water in a bucket. Water holds an endless fascination for many of us, but especially for young children.

They are naturally inquisitive and seem to be instinctively drawn to water. The second age group is adolescence, and in this group males are much more likely to drown than females. Boys tend to be risk takers, and some also seem to be especially lacking in common sense at this age. Among older adolescents, alcohol frequently plays a role in drowning incidents.


preventPrevention

Prevention, prevention, prevention! You may be lucky enough to arrive in time to resuscitate your child, but this is not the way to prevent death by drowning.


  • Never leave your child alone in the bathtub, not even to answer the front doorbell or the telephone.
  • Do not leave buckets of water around.
  • Empty your child’s play pool once your child has finished swimming.
  • Teach your child how to swim at a young age.
  • No one should swim alone.
  • Never leave young children alone around water. Responsible adult supervision is the most important aspect in the prevention of drowning.
  • Teach your child safe water behavior.
  • Do not allow diving into shallow water.
  • When boating, everyone should wear an approved life vest or life jacket that is able to support the wearer so that the head is above water even if the person is unconscious. A responsible and capable adult should be present during all boating activities.
  • Respect the sea! Dangerous back currents and side washes can get the better of even the most powerful swimmer. Swim where there are lifeguards. Obey their instructions. If they tell you to get out of the water, get out!
  • Counsel adolescents about the dangers of drinking and swimming. This combination is just as dangerous as
  • drinking and driving.


skd188621sdcCAUTION

Begin CPR immediately if your child is found unconscious in the water. Call 911.



If You Have a Swimming Pool

  • Swimming pools should be fenced on all four sides with a fence that is at least 4 feet high. The gate should be self-closing and self-latching. Keep the gate locked. Keep a telephone close so that you do not need to leave the pool area to answer it. In the event of an accident the telephone will be close by should you need to call 911.
  • Keep the pool water clean.
  • If your child goes missing, look in the pool first.
  • Learn how to do CPR and keep your certification up to date.
Foreign Bodies
Category: Foreign Bodies, Jul 19, 2011


1. Foreign Bodies in the Ear

IS098R9GXOccasionally while camping or being outdoors, an insect may fly or crawl into your child’s ear. This is extremely distressing to the child (as it would be to anyone). Treatment consists of reassuring your child and gently pouring lukewarm water into the affected ear. The insect will often fl oat out.


If the insect does not come out, medical attention should be sought. Mineral oil can also be gently poured into the ear to drown the insect. It will then need to be removed by a physician. Do not pour liquids into the ear if your child has “tubes.”

Children often put other objects into their ears, favorites being beads and popcorn kernels! Do not attempt to get these foreign bodies out. Seek medical attention instead. Do not put sharp objects into the ear or try to remove the foreign body with a paper clip or similar “instrument.”


Lessons to be learned :

  1. Do not treat your own family.
  2. Cooperate when your child’s doctor suggests that you bring your child into the office to be examined. You may be surprised by what he fi nds.
  3. It is seldom a good idea to start a patient on an antibiotic for earache without examining the patient first.



2. Foreign Bodies in the Nose

It is not unusual for children to put things other than their fingers up their nose. Objects that commonly find their way into the nose are popcorn kernels, buttons, beads, eraser tips,

and candy! More potentially dangerous objects that are put in the nose are small batteries such as camera or watch batteries. These can cause erosions of the nasal septum (the part of the nose that separates the two nostrils).

If batteries find their way into the bowel, they can perforate the bowel. If your child confesses that he has put something up his nose, it is wise to seek medical help immediately. Your doctor may be able to remove it fairly easily, but occasionally this may have to be done by an ENT (ear, nose, and throat) surgeon under anesthesia.

You may be able to see the object in the nose, and if it is protruding, you may be able to remove it yourself. However, do not try to remove it yourself if you cannot easily get hold of it, as you may push it in deeper. Do not try to push it in deeper hoping it will end up in your child’s throat and be coughed out or spat out. If you do this, it may be aspirated into the windpipe or lungs. Rarely, a cooperative older child may be able to force the object out his nose by blowing his nose or by sneezing.

Sometimes a child does not tell the parent what she has done, and the parent gradually becomes aware over time that the child has bad breath and a nasty discharge from one nostril. Rarely, a child who has put an object up his nose will swallow it, in which case there is usually nothing to be concerned about unless it is a battery or a sharp object. The major concern with a foreign body up the nose is that it will be aspirated into the airway or lungs. If your child has a choking episode, medical care should be sought immediately. If your child is in severe distress, you may have to perform the Heimlich maneuver or some similar age-appropriate maneuver.


treatmentWhen to Seek Medical Attention

  • A foreign body in the nose that cannot be easily and immediately removed.
  • A persistent foul-smelling discharge from one nostril.
  • A choking episode or breathing difficulty in a child who was known to be playing with small objects.
  • If you suspect your child may have swallowed a potentially dangerous object such as a camera battery, watch battery, or sharp object.