From the beginning, I knew I wanted to do a topic that related to an emergency situation. As crazy as it sounds, I have always been interested in being involved in hemorrhagic cases. Being introduced to epidural hematoma and subarachnoid hemorrhage once before, I wanted to review a journal that related to intracranial bleeding. And as a result, I felt that this informative journal article on managing intracranial pressure was right up my alley.
The journal article discussed managing intracranial pressure, in relation to the contribution of brain tumors and intracranial bleeding. However, my focus was primarily on intracranial bleeding. The article took on a more informative approach on the common causes of those bleeds, rather than explaining a step-by-step process on how to manage it. Nevertheless, the article did discuss initial assessment standards and diagnostic procedures for these emergent cases.
Statistically, around 50,000 children amongst the pediatric population (16 years or younger) are admitted to emergency department each year, due to some type of head trauma/injury (Paul, 2014). Head trauma/injury could be from sports, rough play, shaken baby syndrome, etc. Furthermore, this accounts for 10% of all pediatric admissions. And with that said, that is an outstanding number. Interestingly, Paul analyzed that 25% of those children do not even lose consciousness. This goes to infer that many of the children and parents today, who experience such a traumatic event, wouldn’t even begin to recognize an intracranial bleed without proper education.
According to Paul, initial assessment standards for raised intracranial pressure suspicions included the ABCD and AVPU approach. The ABCD acronym correlated with assessing (1) airway, (2) breathing, (3) circulation, and (4) disability. While the AVPU correlated with the assessment of (1) alertness, (2) voice, (3) pain, and (4) unresponsiveness. In addition, the Pediatric Glasgow Coma Scale was also mentioned, measuring mental deterioration. Together with a thorough behavioral history, these assessment tools are found to be crucial in managing presenting cases. And finally, it was recommended that neuroimaging (CT scanning) be done within 24 hours of presentation, for confirmatory diagnostics.
Not having any interest with specializing in pediatrics, I strongly believe these kinds of initial assessment skills are essential, regardless of what department you’re in. Being at one of the local hospitals, for my obstetric rotation, I can’t even begin to describe how important it is to use tools and approaches such as the ABCD/AVPU approach and the Glasgow Scale. Regardless if a baby is experiencing raised intracranial pressure or not, any tools to assess someone who can’t even speak to you yet is crucial to being a nurse. What I like about this topic is that it ties in well with advocating for the Vitamin K prophylactic to mothers, in order to prevent hemorrhagic cases. After reading this article I feel much more confident in my ability to educate prima/multigravida mothers on preventative measures.
Finally, in relation to my pediatric rotation at a middle school, I can’t help but mention the importance of education/teaching on a community health level. Reminiscing on simpler times, I constantly see children run up and down the hallways, roughly interacting with their classmates, chatting about after school sports/activities. I feel that, as a future nurse, I have a responsibility to educate parents and children on safety and what non-compliance can lead to. Also, I feel that I have a responsibility in teaching parents on what signs and symptoms to watch out for, if ever unfortunate head trauma/injury occurs in their children.
Paul, S., Green, J., Smith-Collins, A., & Chinthapalli, R. (2014). Managing children with raised intracranial pressure: part two (brain tumours and intracranial bleeds). Nursing Children and Young People, 26(1), 30-37.