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Wounds and soft tissue injuries
Published in Ffion Davies, Colin E. Bruce, Kate Taylor-Robinson, Emergency Care of Minor Trauma in Children, 2017
Ffion Davies, Colin E. Bruce, Kate Taylor-Robinson
Most children in the UK will be fully vaccinated. Routine immunisations are given at 2, 3 and 4 months old, then again preschool and aged 14–15. This confers lifelong immunity. If an immunisation has been missed, the opportunity should be taken to provide it (if there are departmental arrangements to ensure communication with primary care/community colleagues to avoid duplication). In a non-immunised child this will not provide cover in time for the existing wound, so if the wound is dirty anti-tetanus immunoglobulin should also be given.
Patient Assessment
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Because the condition of the patient can change quickly, repeated examinations and constant monitoring of vital signs are essential. This enables the following questions to be answered: Is the patient’s respiratory function satisfactory? If it is not adequate, then the cause must be sought and corrected as a priority.Is the patient’s circulatory status satisfactory? It is essential that the trauma team recognizes shock early in its genesis and intervenes promptly. It is equally important to evaluate the patient’s response to the resuscitative measures. Transient responders are patients who respond to initial volume resuscitation but are either actively bleeding or bleeding recommences during the resuscitation. Thus, their vital signs initially improve but then deteriorate. Control of the bleeding source invariably requires an operation or interventional radiology.What are the extent and priorities of the injuries? The <C>ABC system is used to categorize injuries so that the most dangerous is treated first. For example, problems with the airway must be corrected before those of the circulation.Have any injuries been overlooked? The mechanism and pattern of injury must be considered in order to avoid overlooking sites of damage. Victims of blunt trauma have the injuring force dispersed over a wide area. As a result, trauma rarely ‘skips’ areas; thus, if an injury has been found in the thorax and femur, but not in the abdomen, then it has probably been missed. The patient must be re-examined or their imaging reconsidered.Are tetanus toxoid, human antitetanus immunoglobulin or antibiotics required? This will depend on both local and national policies, which should be known by the team leader.
Surface charge, glycocalyx, and blood-brain barrier function
Published in Tissue Barriers, 2021
Fruzsina R. Walter, Ana R. Santa-Maria, Mária Mészáros, Szilvia Veszelka, András Dér, Mária A. Deli
It is well established that the physicochemical properties of molecules, among them lipophilicity and charge influence the passive permeability of molecules across the BBB.26–28 Negatively charged biomolecules, like sulfated dextrans cross brain endothelial cell layers in significantly lower amounts than neutral ones.29 Large, negatively charged polyanions, like the full length GAG heparin (~15 kDa) and the GAG mimetic pentosan polysulfate (3–6 kDa) do not cross the BBB in significant amount, while low molecular weight heparin oligomers (≤3 kDa) do.30 Cationization of albumin31 or anti-tetanus immunoglobulin fragments32 results in their better penetration across BBB models. In agreement with these experimental observations, an electrodiffusion model was described for the transport of charged molecules across the BBB.33 This mathematical model predicted that the increased negative charge of the BBB would greatly decrease the BBB permeability to negatively charged solutes but would increase that to positively charged ones.33
Intravenous magnesium sulphate infusion as first-line therapy in the control of spasms and muscular rigidity in childhood tetanus
Published in Paediatrics and International Child Health, 2019
Preeti Shanbag, Anupama Mauskar, Sanjeevani Masavkar
All patients received tetanus toxoid and 500 units of intramuscular human anti-tetanus immunoglobulin at admission; they also received intravenous (IV) metronidazole. Additional antibiotics were administered if indicated, for example, in patients with otitis media or wound infection or hospital-associated infections. Wound toilet was undertaken when necessary. Tetanus severity was graded using the Ablett score [15].