For a pediatric karate tournament (children aged 5‑15 years, generally healthy but may have asthma, allergies, or dental braces), what primary and secondary assessments should I be prepared to perform for the most common injuries, what evidence‑based first‑aid protocols should I follow for those injuries, and what essential equipment should I have on hand as on‑site medical staff?

Medical Preparedness for Pediatric Karate Tournament

Most Common Injuries to Anticipate

You should prepare primarily for soft tissue injuries (contusions, abrasions, lacerations), musculoskeletal trauma (sprains, strains, fractures), and dental injuries, as these represent the overwhelming majority of karate-related injuries in children. 1 Less common but critical emergencies include head trauma with potential intracranial injury, respiratory emergencies (asthma exacerbations, choking), and severe bleeding from extremity injuries. 1

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Primary Survey Assessment Protocol (ABCDE Approach)

For any child with significant trauma or altered consciousness, immediately implement the systematic ABCDE approach: 1, 2, 3, 4

A - Airway (with cervical spine protection)

• Assess: Look for visible obstruction, listen for abnormal sounds (stridor, gurgling), check responsiveness by gentle shaking or pinching 1
• Intervene: Open airway using head tilt-chin lift (or jaw thrust if neck injury suspected); remove visible foreign bodies you can easily grasp—never perform blind finger sweeps 1, 2
• Critical pitfall: In unconscious children, the airway requires active support as the tongue commonly obstructs 1

B - Breathing

• Assess: Look for chest/abdominal movement, listen at mouth/nose for breath sounds, feel for expired air with your cheek 1
• Count respiratory rate: Normal varies by age (infants 30-60/min, children 20-30/min) 3
• Intervene: If no spontaneous breathing, deliver 5 rescue breaths (1-1.5 seconds each): mouth-to-mouth-and-nose for infants, mouth-to-mouth for older children 1
• Watch for: Asthma exacerbations presenting with wheezing, increased work of breathing, or inability to speak in full sentences 1

C - Circulation

• Assess: Check brachial pulse in infants (inside of upper arm), carotid pulse in children; assess skin color, capillary refill (<2 seconds normal), and any visible bleeding 1, 3
• Intervene for severe bleeding: Apply direct manual pressure immediately; for life-threatening extremity bleeding, apply tourniquet 2-3 inches above wound (but only if extremity is large enough for snug application before tightening) 1, 2
• If pulseless: Begin chest compressions at 100/min, depth ~3cm in infants (two fingers, one finger-breadth below nipple line), deeper in children (one or two hands on lower third of sternum); compression-to-ventilation ratio 5:1 1

D - Disability (Neurological Status)

• Assess: Check responsiveness level, pupil size and reaction, any seizure activity 2, 3
• Red flags: Altered consciousness, confusion, repeated vomiting, severe headache, or any period of unconsciousness after head impact 5

E - Exposure

• Remove clothing as needed to examine injured areas while preventing hypothermia 2, 3
• Complete head-to-toe examination to identify all injuries, as children may not report pain accurately 1, 3

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Specific Injury Protocols

Head Trauma

Any child with loss of consciousness, altered mental status, severe headache, repeated vomiting, or visible facial swelling after head impact requires immediate EMS activation and hospital transport for CT imaging. 5

• High-risk features mandating immediate EMS: Glasgow Coma Scale <15, periorbital ecchymosis developing after injury (suggests basilar skull fracture), palpable skull deformity, persistent vomiting, seizure 5
• Moderate-risk: Brief loss of consciousness (<1 minute), single episode vomiting, significant mechanism (high-velocity kick to head) 5
• Your role: Maintain cervical spine immobilization if mechanism suggests neck injury, monitor neurological status continuously, activate EMS for high/moderate-risk features 1, 2

Dental Injuries

For permanent teeth that are knocked out (avulsed), time is critical—reimplantation within 30 minutes significantly improves survival of the tooth. 1

• Avulsed permanent tooth: Handle by crown only, rinse gently with saline if dirty, attempt immediate reimplantation into socket with gentle pressure, have child bite on gauze to stabilize, immediate dental referral 1
• If reimplantation not possible: Store tooth in cold milk, saline, or saliva (have child hold in mouth if old enough and conscious); never store in water 1
• Fractured tooth with visible pink/red pulp exposure: Cover with moist gauze, immediate dental referral within hours 1
• Primary (baby) teeth: Do NOT reimplant if avulsed; refer to dentist within days for other injuries 1
• Critical pitfall: Dental injuries in children with braces require careful assessment for soft tissue lacerations from bracket/wire trauma 1

Musculoskeletal Injuries (Sprains, Strains, Suspected Fractures)

• Assess: Point tenderness, deformity, swelling, inability to bear weight or use limb, neurovascular status distal to injury (pulses, sensation, movement) 3
• Immobilize: Splint in position found if deformity present; for suspected fractures, immobilize joint above and below injury 1
• Apply ice: 20 minutes on, 20 minutes off to reduce swelling 1
• Elevate injured extremity above heart level 1
• EMS activation if: Open fracture, severe deformity, absent distal pulses, or inability to immobilize adequately 1

Severe Bleeding

For life-threatening extremity bleeding that cannot be controlled with direct pressure, immediately apply a tourniquet 2-3 inches proximal to the wound. 1, 2

• Direct pressure first: Apply firm pressure with gauze/cloth directly on wound for 5-10 minutes without lifting to check 1
• Hemostatic dressing: If available and bleeding continues despite pressure, apply hemostatic trauma dressing with continued pressure 1
• Tourniquet application: Only for extremities large enough that tourniquet can be snugly applied before activating tightening mechanism; tighten until bleeding stops; note time of application 1
• For small extremities (young children): Continue direct manual pressure with hemostatic dressing rather than risk ineffective tourniquet 1

Respiratory Emergencies

Asthma Exacerbation

• Assess severity: Respiratory rate, work of breathing (retractions, nasal flaring), ability to speak, oxygen saturation if available, lung sounds 1
• Intervene: Administer child's own bronchodilator inhaler (typically albuterol) with spacer: 4-6 puffs initially, can repeat every 20 minutes 1
• EMS activation if: Severe distress, inability to speak, altered consciousness, no improvement after initial treatment, or oxygen saturation <90% 1

Choking (Foreign Body Airway Obstruction)

• If child can cough/speak: Encourage continued coughing, do not intervene 1
• If unable to cough/breathe (complete obstruction):
  • Infants (<1 year): 5 back blows (head lower than chest) alternating with 5 chest thrusts 1
  • Children (>1 year): 5 back blows alternating with 5 abdominal thrusts (Heimlich maneuver) 1
• If becomes unconscious: Begin CPR starting with chest compressions; look for visible object before each rescue breath attempt 1

Anaphylaxis (Severe Allergic Reaction)

• Recognize: Rapid onset of difficulty breathing, wheezing, facial/lip swelling, widespread hives, or hypotension after insect sting or food exposure 1
• Immediate epinephrine: If child has prescribed epinephrine auto-injector, administer immediately into lateral thigh (0.15mg for <30kg, 0.3mg for >30kg) 1
• Activate EMS immediately even if symptoms improve, as biphasic reactions can occur 1
• Position: Lay flat with legs elevated unless breathing difficulty worsens in that position 1

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Essential Equipment List

Airway/Breathing

• Pocket mask or bag-valve-mask (pediatric and adult sizes) 1
• Oral and nasopharyngeal airways (multiple pediatric sizes) 1
• Oxygen tank with pediatric masks and nasal cannulas 1
• Pulse oximeter 1

Circulation/Bleeding Control

• Sterile gauze pads (multiple sizes) 1
• Hemostatic trauma dressings 1
• Commercial tourniquet (CAT or similar) 1
• Elastic bandages 1
• Adhesive tape 1

Immobilization

• SAM splints or rigid splints (various sizes) 1
• Cervical collar (pediatric sizes) 1
• Triangular bandages/slings 1
• Cold packs 1

Medications (if permitted by local regulations)

• Epinephrine auto-injectors (0.15mg and 0.3mg) 1
• Albuterol inhaler with spacer 1
• Glucose tablets/gel for hypoglycemia 2

Assessment Tools

• Penlight for pupil examination 1
• Blood pressure cuff (pediatric sizes) 1
• Stethoscope 1
• Thermometer 1

Dental Emergency Supplies

• Hank's Balanced Salt Solution or cold milk for tooth storage 1
• Sterile saline for rinsing 1
• Gauze for bleeding control and tooth stabilization 1

Documentation/Communication

• Emergency contact forms for all participants 1
• Medical history forms (known allergies, asthma, medications, dental braces) 1
• Code/emergency documentation sheet 1
• Cell phone for EMS activation 1

Universal Precautions

• Disposable gloves (multiple sizes) 1
• Face shields 1
• Hand sanitizer 1
• Biohazard disposal bags 1

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Critical Operational Protocols

EMS Activation Criteria

Activate EMS immediately (after 1 minute of basic life support if performing CPR) for: 1

• Cardiac or respiratory arrest 1
• Altered consciousness or significant head trauma 5
• Suspected spinal injury 1
• Severe breathing difficulty not responding to treatment 1
• Severe bleeding not controlled by direct pressure 1
• Suspected fractures requiring hospital evaluation 1
• Anaphylaxis 1
• Any injury where you are uncertain about severity 1

Hand Hygiene

Wash hands or use alcohol-based sanitizer before and after examining each child to prevent infection transmission. 1 This is the single most important infection control measure. 1

Family Communication

• Designate someone to speak with family during emergency stabilization 1
• Provide clear, calm updates on child's condition and actions being taken 1
• Obtain emergency contact information before event begins 1

Documentation

• Record time of injury, interventions performed, vital signs, and child's response 1
• Note time EMS was called and arrived 1
• Document any medications administered (dose, route, time) 1

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Common Pitfalls to Avoid

• Never assume "no visible head wound" means no serious brain injury—intracranial hemorrhage and skull fractures frequently occur without external signs 5
• Do not delay EMS activation while attempting multiple interventions; after initial assessment showing serious injury, call immediately 1
• Avoid blind finger sweeps in choking children—only remove visible objects you can grasp 1
• Do not reimplant primary (baby) teeth if avulsed—only permanent teeth should be reimplanted 1
• Never apply tourniquets to extremities too small for proper application—use direct pressure with hemostatic dressing instead 1
• Do not rely solely on child's report of pain—perform systematic head-to-toe examination as children may not accurately report all injuries 1, 3
• Avoid moving children with suspected spinal injuries unless in immediate danger 1, 2