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I know everyone okay or well, sorry. A company with used today. I am. And I have, um, one of the nurse practitioner's here in the department afternoon. It's morning sugars. Say, I'm going to take you through some pediatric, a little injuries. There's any questions or Berries. I'm not their talents to them. Um, but I'm sure they are. Someone will happily answered them for me. Saslow No traveling this for. It's pretty basic. What? Assassinate like Children is uncommon. Be very difficult. And it often be it if they're sick or if they're injured. But some of these key things are important to remember. And you've had the chops on the holding on P and management. But it is absolutely key. A good corporate of parent good history taken, which will capture like no no accident. Well, potential things good physical examination always remember not where they say they're sore might know, actually being where their source, um, good communication skills first from we will look up is a cold elbow. Um, it's quite common when you see the child common in. So when we pulled over what you know is just the annular ligament at the end of the radial head, which allies the rotation than the real grief. Um, off the proximal know it gets subluxed on the best. Diagnosis is made completely on your good history. Take a, um, will be coming in with a history of that being swing. Um, which I did buy the arm that you can see in the picture. There's a southern pill in the arms, still on the shot across the room or a tug on the arm when they were trying to get away with it by the child were presented. The cold elbow is that it's not used, you're on the arms, generally held on extension on the forearm is very slightly any funny, is that but definitely no to use in the arm. There never tends to be much no spelling or brazen that sound. Help get them. They're no, really. That's where the what? Well, distress, um, as an ingredient. So you trying to Simponi more flecks? Um, on the child will certainly resist on the of cry scream, Um, on it from the cold gel wasn't there on the production. And they shouldn't be anything of all for an X ray. If you're confirmed diagnosis unless you're thinking the balance of differential a cold. But there's been a full neutral mother's up with medication whatsoever for a next trick. And your Children. I have never in this century a showed very signature right from the rash cream I put some on. It's done. Yes, plus or minus analgesia was a mom. I really is a harsh know. Maybe it's ages who will have them to you, but I ever plus or minus analgesia, um, on the reduction. Then I tend to do this often. One not as discipline flex forearm with my finger or someone will brother, retail head And then you hear the beep. Hope on it, girl Bargain confirmation of it, don't it is that the child starts to use the arms too. So really, the put the money under the weight room, get him some fluids, see how they go after about 10 15 minutes in the should generally be used in the arm again. And then just remember, on the discharge, probably bicep. I thought maybe segment that her mind, little bit swing in the arms of the risk of it happening again, alleges I have just less, um, back to my last slight on I realized and talk really fast. Um and I am listen to go back and re record it. So if you have any questions, you don't understand what I say or I'm told them nonsense and place Just I hope point you back in a lurch Feulner or someone there. But I'm gonna look at pediatrics elbow X rays on uh, well, they remind things, but they're not actually that complicated once you get into them. But that certainly when I started I I felt I had no politically. If I did X rays and nor the I can him to still know much about them. But I'll give the Upper East overview on pediatrics elbow X rays. We're gonna look at the kids six pulse Indication centers, depending on how you have learned that it's either the new monitor cry too or cry toll, whether you call it an external at the colon died or the last electrical day. Um, this sequence is really the symptoms is really important when you're analyzing the kids X rays. Not really important is the age is that they appear out. You don't make to get caught up in that, but it's approximately ages. Form three by 79. 11 for the sex ossification. Seven hours. It's more of the order. And that will keep you right when you're looking at something I'm thinking. Is that avulsion? There's that set, right? You're thinking I'm not sure you go in the sequence and you don't have a real head. Are you saying that's the, um, lateral epicondyle off that humorous? Well, then, that's definitely know that if the radio head and all the other things that also vacation somewhere some of the fugitive, then that would be a fracture. So the order is really important. We're going to just look at your lanes, um, urological lanes on X rays. This is old good tips. I'm creature you maybe? No. Well, that's you're already so I'm not sure been preaching to the converted or if this is all new, Um, but using these two country like if she had a medication list Oh, whether it's something is normal or abnormal. First line in the radiocapitellar lying on you can get that on both the lateral on the AP a low the AP Yes, um as reliable as about the lateral is. So if you draw a horse on the line through the proximal and off the radius, it should go through the summer of the capital. A man, if you look at the anterior general lying, Um, when you draw a line a little down to your cortex about humorous, it should go three at least a third of that capital. Um, should lie on tier two on if it doesn't, um, you're thinking possibly a super cold Georgia there with your radiocapitellar night. Um, if you're not getting nearer line going through the center up capital, um, on your radio kept Taylor lying to be thinking that the radius is a circuit available joint abs. Another green thing to look for on X ray. I love when x rays give you love, Louis. Hence that there's something not right That's easy for my simple mind. And so your check up about pads on the lateral theory. Um, if there's a non interior about father's set from distort up, this place started from the interior like, um, then we call that a seal sign like the seal on a boat so that along with or on its own with a posterior fat part of my posterior fat pads or not usually visualized as they set with, um, a girl and force of the distal humerus to if you're definitely getting the posterior padowitz Definitely a sign of an old fracture. You can have an anterior about God sitting night normally, but no sentinel creating the big seal saying that you do see, um, Brown and I'm terribly along the so are flat. I am a flat on purely a longer humorous, but you shouldn't be seeing that. So a seal sign Foster minus a posterior fossa. How pads or posterior problem? So the rule signs that there's a fracture is gonna make it on the super conjurer fractures, for we would see quite that phase. Unfortunately, quite, Coleman Onda also, because the problem most attention of the lymph threatened on any form of elbow injury with the chills child. So the second it was common type of pains. Fracture of the distal radius. Trump's up. Um, certainly the most common elbow fracture And kids, um, Paxil. The ones are roughly ages 40. It anywhere between two and tam boys and girls are the see, um, the extension type of austerely displaced type off Super Contra fracture is a mechanism, a simple full on a night stretch tab on the collection, which is a very rare It's more on a fixed. Call him on a flexed elbow. We wouldn't ready to see as much about classify, um, super cultures. I don't know. I suppose if you're very much under orthopedics and whether you need to be right, and I and you go a certain agree it of Super controller, um, suppose more knowledge. And that is more what you need to know about. Um, hi there. Classified Pam's on high. Um, when it display and effort, this place is what direction of this place is and it's a collection. Tight are quite rare, is I said that's what that that's still fragment. This place is on terror like, um, extension time, which much more common is on the distal fragment displaces prostate. I went into space posteriorly, and we can use the garden, the classifications. How you did over by that So agreeable one is, um, a nondisplaced supracondylar. Pressure on your green, too, is that it's displaced on the anterior aspect of the humerus, but you've gotten intact. Austere e er term sort of hinge there at the back. And then you agreed. Three years. No. Create. Um, that's complete disruption. And that is that is the one that can be done through. Um, tree could potentially be a scale that certainly have three is the one for your think. I'm Yup, definitely. There's potential of lemon threatening injury. Just a quick slight on there. That my so just by virtue of where everything is rare, all the neurovascular, um, structures or sent you that you can see that when, uh, super condo fracture. How? Um, so that's agreed. Three displace posterior like course. There's potential there for immediate complications to be associated to be a little threat month. Um, just by where the position of the nerves on the blood vessels are just gonna look quite a steps present. Um, these kids present in a law PM and, uh, PM, as you know, could be displayed in different ways. That child could be literally screaming their head off there. The lawyers personal the department, But quite often we would see those really, really, really bad. So contour fractures where there's a dimple in of the skin, which we'll talk about my, um on the literally are I'm hardly speak with the p. M. You say very little very feels so it looked like there are bites and collapse. So pianism, not something for these. Absurd that refusal toe move the arm. The arm is just hanging doing by their their site. There's normally a gross owing of swelling on the form of that, there can be a breeze in. And then, as I said, if you're starting to see dumpling and Papa and now the quote capital Fosa out, spend your at some planning more serious injury. Um, so there's the lightly higher. Like, uh, there's a higher likelihood of a heart Erie alendronate, Um, and significant swelling on orthopedics would say that would make them for have a more difficult close reduction. This is obviously I never present with a displaced supracondylar. And you're not going to with a nondisplaced several contour. Get that group screw swell. And you're not going to get bruising and dependency. And this is talking about this or agreed to you Grade three separate off the that I am. You know what? That's anybody. You should be doing this really, really them injured It's just checking to see if there weren't deficit. There is if there's any deficit. Um, checking that prosecutor assessment, help it in the radial pulse. Um, if you can't say that, you may need a Doppler to confirm it compared to the other side. Chicken with the hounds and the fingers, the profusion, the warmth, um, checking the sensational save you a little more medium sensation on, then looking at the motor function. Just put this in for more function because I like simple things. Um, helps you maybe to remember. But I always assess more function with throat, paper, scissors. Okay. And I think the kids kind of like that approach you can. Let's take whatever approach for this. Um, uh, good thing to have in your head, um, wrote over submitted a nerve paper. Radial nerve. Your says there's your older and then during the okay sign as assassin, interior of the rules history of, um, abnormal and for the super cultural fractures. Because neuropraxia always, um, the anterior girl says nervous llamas effect of the most, um, and some cultural fractures and then the radial nerve. But the the next Coleman, you're a proxy. Always my mom, it went up. These, um, like, I'm not going to really get that going over analgesia on things like that can that, you know, has covered other simple things. Get them clothes and couples to relieve in that it's not tight. We put them until on our backs love always a box. I've never felt so because of swelling on a very gross think roast, a deformed arm, You come back, stop them before they go to x ray for pain relief for you know that that's practioner. Anyway, um, so an agreed to you in grade three when you're getting the cast on very, very important late. You're casting them in there, sort visitation there holding or start no more than 34 to 32 48 degrees of extension or no bringing that arm hoping to night they were No, Richard. No. I just, um, arm that's hanging. Um, I'm not going to make the situation worse, Um, making sure that the cast, when it was only have access to palpate the real pulse. Um, remember that your neurovascular examine must be don't bathe for were on after you do anything with them. Um, and especially important after I cast, um, other things and could kick in the child fasting or basically get not shake X ray. We haven't, um, um cast immediately. Good, clear documentation, then f u r and enjoying it by the neurovascular Stop us or there is deficit. Then it would be contacting orthopedics and the royal on if they're in your ashtray and tax and you are contacted trauma, orthopedics and all the gallon. Thank you very much for listening. Hard to know how high that has gone for. I don't know what the old and says It's the weather. It was appropriate for use or not. Um, but it's just a couple of things available. Injuries mostly been the super conjure in the filled out Because the Jews common things that we would say Well, as other things, not shale like anything. If you don't know, just ask. Um, everyone were apartment mean? There's lots of things I don't know. I'm always happen to ask. So you're not sure? Just asking someone somewhere will have a bigger brand on no more. What I or anybody else to us? Um, So yeah. Thanks. Any questions you have over 18? Oy. Name on the fuel for free. They're the ones that's in the background today. Thanks very much. Oh,