injuries in children
TRANSCRIPT
Injuries in ChildrenInjuries in ChildrenDr. Vivek M. RegeDr. Vivek M. Rege
Pediatric & Neonatal Surgeon
Saifee HospitalSaifee Hospital
Bhatia HospitalBhatia Hospital
Wadia Hospital for ChildrenWadia Hospital for Children
Fortis HospitalFortis Hospital
Dr Vivek Rege Pediatric Surgeon
Types of InjuriesTypes of Injuries
• External blunt injuriesExternal blunt injuries
• External/Visible cut injuriesExternal/Visible cut injuries
• Internal blunt injuriesInternal blunt injuries
• Penetrating injuriesPenetrating injuries
Dr Vivek Rege Pediatric Surgeon
Mechanism of injuryMechanism of injury
• Massage in newbornsMassage in newborns
• Fall while walking/running/sports/heightFall while walking/running/sports/height
• Vehicular accident: pedestrian/ in vehicleVehicular accident: pedestrian/ in vehicle
• Crush injury: door, heavy objectCrush injury: door, heavy object
• Sharp object : impalement/ bitesSharp object : impalement/ bites
• Large object falling on child: chest / Large object falling on child: chest / abdomenabdomen
Dr Vivek Rege Pediatric Surgeon
Site of InjurySite of Injury
• Head injuryHead injury
• Face , neck, mouth injuryFace , neck, mouth injury
• Chest injuryChest injury
• Abdominal injuryAbdominal injury
• Limb injuryLimb injury
Dr Vivek Rege Pediatric Surgeon
Breast abscess following massageBreast abscess following massage
Breast abscess following massageBreast abscess following massage
Abrasions due to dragging along ground by 3 Abrasions due to dragging along ground by 3 dogs who attacked this boydogs who attacked this boy
Dr Vivek Rege Pediatric Surgeon
Following a dog bite - abrasions & woundFollowing a dog bite - abrasions & wound
Major cutMajor cut
AbrasionsAbrasions
Dr Vivek Rege Pediatric Surgeon
Deep wound - includes skin & musclesDeep wound - includes skin & muscles
Dr Vivek Rege Pediatric Surgeon
Dr. Vivek M. Rege
CLWCLW
• Scratched by a PumaScratched by a Puma
• Injury on the noseInjury on the nose
• Active bleedActive bleed
• Deep cutDeep cut
• Requires suturingRequires suturing
Dr. Vivek M. Rege
After suturingAfter suturing
Excellent healingExcellent healing
Good scarGood scar
Large cut across tongueLarge cut across tongue
Always to be done under anesthesiaAlways to be done under anesthesiaDr Vivek Rege Pediatric Surgeon
CLW tongue
Dr Vivek Rege Pediatric Surgeon
After suturing with self absorbable suturesAfter suturing with self absorbable sutures
CutCutDr Vivek Rege Pediatric Surgeon
After suturing the under surface of the tongue woundDr Vivek Rege Pediatric Surgeon
Dr. Vivek M. Rege
Crush injury to the fingerCrush injury to the finger
Dr. Vivek M. Rege
Crush injury all around fingerCrush injury all around finger
Finger crushed in door Finger crushed in door
Finger crushed in door Finger crushed in door
After cleaning & suturing
Final result 10 days
Finger Finger was was
caught caught in the in the
door and door and the skin the skin
was was avulsedavulsed
Dr Vivek Rege Pediatric Surgeon
Avulsed skin brought along in plastic Avulsed skin brought along in plastic bagbag
Dr Vivek Rege Pediatric Surgeon
After total healing - excellent resultAfter total healing - excellent result
Dr Vivek Rege Pediatric Surgeon
Child fell on the handle of cupboard
Injuries requiring suturesInjuries requiring sutures
• Must be recognised earlyMust be recognised early
• Referred to a surgeon earlyReferred to a surgeon early
• Stop all oral intake immediatelyStop all oral intake immediately
• Send to a hospital directlySend to a hospital directly
• Suturing must be within first 6 hours Suturing must be within first 6 hours ideallyideally
Dr Vivek Rege Pediatric Surgeon
Head InjuriesHead Injuries
• Ask if child had unconsiousnessAsk if child had unconsiousness
• Ask if child had bleeding ear/nose/ mouthAsk if child had bleeding ear/nose/ mouth
• Ask if child had convulsionAsk if child had convulsion
• Ask if child has vomitedAsk if child has vomited
• Check if child is orientedCheck if child is oriented
• No oral feeds till seen by doctorNo oral feeds till seen by doctor
Dr Vivek Rege Pediatric Surgeon
Blunt injury – Chest & AbdomenBlunt injury – Chest & Abdomen
• Blunt injury caused by fall, sports, an object falling on Blunt injury caused by fall, sports, an object falling on the bodythe body
• External injury may look small – bruise, scrape or External injury may look small – bruise, scrape or hematomahematoma
• Internal injury may be very major – tear of an organ or Internal injury may be very major – tear of an organ or vesselvessel
• NEVER take chest / abdomen injury casually – go to the NEVER take chest / abdomen injury casually – go to the nearest hospital and shownearest hospital and show
Dr Vivek Rege Pediatric Surgeon
Blunt Injury ChestBlunt Injury Chest
• Child was playing around a scooterChild was playing around a scooter
• Scooter accidentally fell on her chestScooter accidentally fell on her chest
• She developed swelling from chest She developed swelling from chest upwards to face and down to abdomenupwards to face and down to abdomen
• Difficulty in breathing progressiveDifficulty in breathing progressive
• Time lag: 2 hours after injuryTime lag: 2 hours after injury
Dr Vivek Rege Pediatric Surgeon
Dr Vivek Rege Pediatric Surgeon
Dr Vivek Rege Pediatric Surgeon
Swelling up to Swelling up to face , crepitations face , crepitations
all over upper all over upper body due to body due to
leakage of air leakage of air from the lungs from the lungs
outsideoutsideSternal fractureSternal fracture
Dr Vivek Rege Pediatric Surgeon
Lung Lung collapsed, collapsed,
air air outside outside the lungthe lung
Tear in Tear in the right the right
main main bronchusbronchus
LungLung LungLung
Dr Vivek Rege Pediatric Surgeon
Full Full recovery recovery
before going before going home from home from the Hospitalthe Hospital
Dr Vivek Rege Pediatric Surgeon
Fall from the loft on an open stoveFall from the loft on an open stove
Chest Injury(Penetrating)
Dr Vivek Rege Pediatric Surgeon
Penetrating injuryPenetrating injury
• Third rod of stove inside the childs’ chestThird rod of stove inside the childs’ chest
• No difficulty in breathingNo difficulty in breathing
• No gross bleedingNo gross bleeding
• No major organ/vessel damageNo major organ/vessel damage
• Child was very luckyChild was very lucky
Dr Vivek Rege Pediatric Surgeon
Fall from the loft on an open stoveFall from the loft on an open stove
Chest Injury(Penetrating)
Dr Vivek Rege Pediatric Surgeon
Trachea & Esophagus normal no subcut. emphysema
Penetrating Injury neck midline fall on an Iron rod
Dr Vivek Rege Pediatric Surgeon
Fall on a sharp compound fenceFall on a sharp compound fence
Entry wound shows muscles cutEntry wound shows muscles cut
Dr Vivek Rege Pediatric Surgeon
Exit wound in floor of mouth
Tongue
Dr Vivek Rege Pediatric Surgeon
Glove finger seen inserted from entry wound
Dr Vivek Rege Pediatric Surgeon
Tract of the iron rod seen
Dr Vivek Rege Pediatric Surgeon
Muscles sutured in midline
Dr Vivek Rege Pediatric Surgeon
Dr Vivek Rege Pediatric Surgeon
Exit wound also closed
Dr Vivek Rege Pediatric Surgeon
Post operative healing excellentDr Vivek Rege Pediatric Surgeon
Burns due to Kerosene can falling on the boys head Burns due to Kerosene can falling on the boys head & face due to rats on the loft. Boy was sitting in & face due to rats on the loft. Boy was sitting in
front of a stovefront of a stove
Dr Vivek Rege Pediatric Surgeon
After local application of Amniotic membraneAfter local application of Amniotic membrane
Dr Vivek Rege Pediatric Surgeon
Healing of burns on Healing of burns on the face and neck & the face and neck & trunk on the backtrunk on the back
Dr Vivek Rege Pediatric Surgeon
Dr Vivek Rege Pediatric Surgeon