165. Peds trauma

Question 1

7 anatomical differences that put peds at risk

Answer 1

1. Larger head and thinner cranial bones
2. more anterior and exposed spleen and liver
3. kidney less protected and more mobile
4. chest elastic and allows for pulm injury without skeletal injury
5. growth plates not closed
6. more tenuous spinal cord blood supply
7. more rapid heat loss

Question 2

Primary assessment of airway

Answer 2

• look and listen for signs
• immobilize
• ETT if cannot maintain
  o Unable to BMV
  o GCS < 9
  o Resp failure
  o Presence of decompensated shock despite fluids

Question 3

Assessment of breathing

Answer 3

• chest rise
• paradoxical breathing
• too fast or slow
• BMV if necc.

Question 4

4 cuases of poor breathing

Answer 4

o Pain
o Decreased mental
o Diaphragm fatigue
o Pulm injury

Question 5

4 ways to assess circulation

Answer 5

o HR
o Cap refill
o Peripheral pulses
o Vitals

Question 6

AVPU score

Answer 6

 Alert
 Verbal stim
 Painful stim
 unresponsive

Question 7

What it assess in disability

Answer 7

AVPU
pupils
extremity and tone
posturing and reflexes

Question 8

AMPLE Hx

Answer 8

o	Allergies
o	Meds
o	PMH
o	Last meal 
o	Event and environment

Question 9

IV methods and fluid resus

Answer 9

• IVs and monitors
• Central line in femoral if need be
• IO is safe and quick
• Umbilical vein if up to 10d
• 20ml/kg fluids
• if no response to 40, need to start blood
• if massive, then MTP 1:1:1

Question 10

Signs of head injury

Answer 10

irritable
lethargy
vomiting
personality changes
seziures

Question 11

6 signs of ICP in infants

Answer 11

full fontanelle
split sutures
ALC
paradoxical irritability
persistent emesis
downward gaze and unable to elevate

Question 12

9 signs of ICP in children

Answer 12

HA
stiff neck
photophobia
ALC
persistent emesis
CN involvement
Pailledema
HTN, brady, hypoventilation
posturing

Question 13

5 layers of scalp

Answer 13

SCALP
	skin
	connective tissue
	aponeurosis
	loose areolar tissue
	periosteum

Question 14

3 associations of poor outcomes in skull #

Answer 14

 overlying vessel
 depressed
 diastatic – through sutures

Question 15

3 non-pharma mgmt for ICP

Answer 15

raise head
head in midline
hyperventilate
- 30-35

Question 16

2 hyperosmolar agents

Answer 16

mannitol - 0.25-0.5 g/kg

3% - 10ml/kg

Question 17

5 issues to control to prevent worse ICP

Answer 17

Euvolemia
CBF
- pressors if needed
Sedation
- can use NMBA if needed
Fever
- tylenol
Seizures
- prophylaxis controversial, but treatment not

Question 18

4 indications for xrays

Answer 18

o part of skeletal survey for child abuse
o assess function of VP shunt
o penetrating wounds of skull
o suspicion of FB under a scalp lac

Question 19

6 indications for CT head in <2yo

Answer 19

	AMS
	GCS <14
	Palpable skull #
	Temporal, parietal, occip hematoma
	LOC > 5 sec
	Not acting normally

Question 20

6 indications for CT head in >2yo

Answer 20

	GCS <14
	AMS
	Basilar skull # signs
	LOC
	Vomiting
	Severe HA

Question 21

3 differences in spinal cord injuries

Answer 21

• less common, but tend to get higher level #s
• fulcrum at level of C2-3
• more likely to get SCIWORA
  o spinal cord injury without radio abnormality

Question 22

4 signs of spinal cord injury

Answer 22

o Paralysis
o Paresthesia
o Torticollis
o Priapism

Question 23

5 criteria that must be met to not do imaging in >3yo

Answer 23

o	no midline tender
o	no neuro def
o	painful distracting injury
o	hypotension
o	intox

Question 24

3 criteria that must be met to not image < 3yo

Answer 24

o not MVC
o non-accidental
o fall from less than 10 feet

Question 25

signs of spinal shock

Answer 25

usually from above T1 | o usually lower extremity flaccidity

Question 26

7 possible thoracic trauma injuries

Answer 26

``` o pulm contusion o PTX o Hemothorax o Myocardial injury o Pericardial injury o Vascular injury o Rib # ```

Question 27

5 signs on PTX

Answer 27

```  Chest trauma  Tachypnea  Resp distress  Hypoxia  Chest pain ```

Question 28

indication to manage PTX conservatively

Answer 28

< 20% | no tension

Question 29

MGMT of hemothorax

Answer 29

CT placed posterior

Question 30

3 indications for OR thoracotomy in hemothorax

Answer 30

 Blood loss > 15ml/kg  Persistent blood loss  Air leak

Question 31

2 indications for ED thoracotomy

Answer 31

 Penetrating |  Arrest <15 minutes

Question 32

MGMT of traumatic diaphragmatic hernia

Answer 32

ETT and OR

Question 33

signs of diaphragmatic hernia

Answer 33

o Sudden increase in abdo pressure | o Look for lap belt only pattern

Question 34

6 signs of abdo injury

Answer 34

``` o tachypnea from inability to vent o abdo tender o ecchymosis o shock o abdo distension o Kehr’s sign – L shoulder pain wth spleen ```

Question 35

6 indications for laparotomy

Answer 35

``` HD instability despite aggresive resus HD instability and +FAST transfusion on >50% blood volume xray pneuomperitoneum, bladder rupture, Gr V renal injur GSW to abdo Evisceration signs of peritonitis ```