You are working on an RRV as a solo Paramedic when you are called to RTC, vehicle vs pedestrian. You are informed by control that a child has ran out in front of a car and has been hit approx. 30 mph. Back up EA is on route 15 minutes.
You arrive on scene and can see a crowd surrounding a child on the floor. You can hear them crying, and are ushered over to help. Witnesses explain that the child ran out in front of the car, was hit and then thrown onto the tarmac. The child fell onto an outstretched arm and seems to have broken it.
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You approach the patient with your kit, the child’s mum and older sibling are trying to comfort her. The child is 4-years-old, alert and crying. There is grazing and cuts down both arms, a contusion on the right side of her head, and a fracture to the left wrist/arm. What are your first actions
You explain to mum that you are going to check her child over, and that an ambulance will be along shortly to transport to hospital. You quickly assess no catastrophic haemorrhage, no current issues with airway. You see the child is in a recovery position on her right side with mum at her head keeping her calm. Is it acceptable to get mum to keep the patient in that position and hold her head in a neutral alignment
You explain what you want mum to do and she happily agrees to assist, you continue on with your assessment as mum maintains c-spine under your guidance. On assessing the thorax and back, there’s no obvious deformity or injury. Auscultating the chest, there is equal, bilateral air entry. On circulation, the patient has a radial pulse of 120 bpm and no obvious signs of any internal haemorrhage. Assessing disability, there is a contusion on her right forehead potentially from the impact of the car, but the patient has been alert and conscious throughout.
The patient is in a lot of pain with the wrist and is the main cause of her upset. It looks broken but is not grossly deformed. What management can you look at to help
You explain to the patient and mum that you’re going to try and help with the pain. You ask mum if they are allergic to anything, and any other medical history, to which mum replies none. You get some Infant Paracetamol 120 mg in 5 ml, without any contraindications present, what is the initial dose
The patient takes Infant Paracetamol with no issues. Mum asks ‘You’re not going to use needles are you, she is terrified of them.’ You let mum know that you will avoid using needles unless absolutely necessary as you don’t want to distress the patient any further.
In this situation, what other medication can you consider to help with pain relief
You show the patient how the Entonox works and they manage to get some inhalation of it. Can Penthrox currently be administered for children in the UK
With the analgesia on board, the patient has calmed a lot, making it much easier to manage observations and splinting the limb. You quickly do baseline observations with no concerns. Looking at the limb, you manage to splint it with a vacuum splint. The Ambulance arrives and ask what you need for the patient. You advise that you would like some paediatric immobilisation equipment. The crew discuss if the patient really needs to be immobilised. You answer
You discuss that due to distracting injury and such a young age, you would like the patient immobilised as best possible. The crew grab the equipment and immobilise the patient. The patient remains calm with mum’s presence and you get them into the back of the ambulance.
Given the factors involved in this case, is it advisable to contact a trauma desk to determine the best location for the patient