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The crew arrive to find a child who has fallen off the trampoline

Hello we’re from the ambulance service. I’m Jordan and this is Cameron. Who do we have here? This is Luther. Hello Luther. What’s happened? He has just fallen off the trampoline, he landed on his elbow and he’s bumped his head. Ok alright then. Did you see him fall off? Yes. Did he go unconscious at all? No. Cried straight away from falling? Absolutely. Ok so pain in this elbow? Yes, his left elbow. Let me just start up here. Luther, have you got any pain in your neck at all? No? Ok. Let’s have a little feel of your head. He’s got a bit of a bump on the one side. Can you move your legs for me? Can you straighten those?
Do they feel ok? Perfect. Is this your good arm? Yes. Does that feel ok? (Luther winces) That one hurts… ok…
All down here. Is that sore? Yes.
So he’s fallen; he’s got a minor head injury; no loss of consciousness. He hasn’t vomited since he’s fallen? No. Ok, he’s complaining of pain in his left elbow, it looks a bit swollen. It’s quite tender.

Sporting injuries are very common, especially among young children with few fears of heights and self preservation! Specific injuries to consider are dislocations or fractures, and be aware that these can happen together. These injuries are painful and children are anxious, as are their parents.

The primary concern is neurovascular status, however the patient and parents primary concern will be pain, and this needs to be considered early.

With limb injuries it is unlikely that there will be threats to airway, breathing or circulation but just because the arm may be broken it doesn’t mean there hasn’t been a significant head injury as well. The child may be drowsy or drifting out of consciousness so it is important other life threatening injuries are considered on initial assessment.

In relation to the limb itself ensuring a peripheral pulse and perfusion to the distal aspect it is important. If the child has been out in the open air for some time there peripheries may be quite cold anyway but there should be no discrepancies between hands and feet. If the pulse is present but not easy to find some teams will mark the spot where the pulse has been felt.

Providing analgesia is a key priority which is a combination of immobilising the injury and giving some medication. It is sometimes easier to do latter before the former which then decreases the need for the latter!

What are your options for pain relief?

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Emergency and Urgent Care for Children: a Survival Guide

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