Peds Trauma

[Dustdevil]

I had a call for a 1 month old who fell out of a bed (?). She fell approximately 2.5 feet. Not 1.5 times height but I still treated as a trauma as piece of ______ mother did not witness fall. We have nothing to immobilize someone this small.

That's because there is no need to immobilise somebody this small, in most cases. Ever seen an x-ray of a 1-month old? There isn't enough bony structure to the spine to break or subluxate, at least from this low MOI. The possibility of CHI exists, and should be considered. But immobilising the child -- which you witnessed -- is just going to piss the kid off, potentially increasing iCP on the rare chance he has a CHI.

Like they always teach, kids are not just little adults. They have a completely different set of concerns for us to deal with. And if he had a neck that was easily broken, he never would have been born a month ago, lol. He suffered more trauma during delivery than he would have from a 1.5 foot fall.

[p3medic]

The mechanism here is unlikely to involve c-spine injury, and I agree with the much more likely posible of closed head injury as Dust stated. As for the pediatric spine being more forgiving than that of the adult, I would agree, however the acronym SCIWORA should not be forgoten. Serious Cord Injury Without Radiological Abnormality. Although they are less likely to fx, they are not immune to serious cord injuries, if the mechanism warrants, immobliize.

[medic14527]

you have to remember infants dont tense up when they fall, so the instance for severe injury is low but can still be possible. using the ked for imobilization is the best idea I know of if you dont have a pedi-pak or papoose

[firedoc5]

I had a call for a 1 month old who fell out of a bed (?). She fell approximately 2.5 feet. Not 1.5 times height but I still treated as a trauma as piece of ______ mother did not witness fall. We have nothing to immobilize someone this small.

Any ideas or things that worked for you? Are there products I could show to my EMS officer?

Thanks in advance for any replies.

I find it hard for a one month old to move around enough to "fall out of bed" in the first place. Even if they do move around a bit, I don't think they can actually motivate enough. The mother must have had the baby near the edge or even dropped the baby and blamed it on a fall. Seen it all too often.

[Dustdevil]

The mother must have had the baby near the edge or even dropped the baby and blamed it on a fall. Seen it all too often.

That's exactly where my index of suspicion was leading me too. Abuse or neglect. I'm not one of those people that jump to that conclusion on every baby with a bruise, but the whole "I didn't see what happened" ignorance act just raises a flag with me.

[Baldrick]

Imobalizing kids is difficult and sometimes causes more harm the good particuly in the compative child. As others have said with a biger kid then a KED can be used. One option for a child of the age you describe is a Vac splint, lift the child stright on to it the wrap it up and suck the air out it will conform to the body and allow for the larger head found with kiddies. It oftern needs to be combined with a healthy amount of tape.

I am not sure what you are able to do but with the combative child there is obviously a case for geting someone out to sedate them or RSI them if required.

[ccmedoc]

I am not sure what you are able to do but with the combative child there is obviously a case for geting someone out to sedate them or RSI them if required.

:shock:

[Baldrick]

:shock:

That was less in referance to the above situation but a genral comment on kids with trauma and a consideration not a specfic cause of action. I was not suggesting evry distred child gets drugs etc.

[nypamedic43]

The KED works wonders if you roll the sides back. A papoose board is expensive and not many organizations have the $$ for them. I have to agree with firedoc and Dust...a 1 month old baby does not move around much, except maybe extremities. I would have a very high index of suspicion to mom maybe dropping the kid.

I dont see a 1 month old as being combative at all, most of the time swaddling one so little will calm them right down. Its a comfort and warmth thing. And I must ask why on earth RSI'ing a 1 month old who is mad and voicing his opinion (as only he can) would even come to mind. The fact that he is squirming and screaming tells me that he really doesnt have a trauma injury but that the precaution should be taken. Better to be safe than sorry.

Mom isnt gonna really tell the truth in this instance, accidents happen, but to say that a 1 month old squirmed enough to fall off a bed, I would really have to question that, without being accusatory.

[paramistress]

A vest-style extrication device, such as a Kendrick

Extrication Device (KED), can be used to immobilize the

head, neck, and spine. In infants and toddlers, the KED

may be more effective than a spine board, as it helps to

immobilize the child’s trunk. It can be adjusted to fit any

small child. Place padding under the child’s back from the

shoulders to the buttocks. Fold the side pieces of the KED

along the sides of the child’s head and tape them in place

across the forehead. Leave the forehead exposed. Never

tape across the neck, as this can interfere with the child’s

airway and breathing.

I usually use the KED for peds immobilization becasue the idiot that used the pedi board before me never puts it away correctly and the velcro straps are usually all tangled up! The KED is also great for hip immobilization. Just put it on upside down.