Approach to acute paediatrics, Injured child Flashcards
How are children different to adults?
- Anatomically
- Physiologically
- Compensate well & decompensate quickly
- Communication challenges
- Parents usually present (& anxious)
How is a child’s airway different?
Large head to body size, short necks & large tongue
Obligate nasal breathers
- Nasal passages easily obstructed
Compressible floor of mouth and trachea
High anterior larynx
What are the breathing differences in children and how is that relevant in increased resp work?
Small total surface area for air tissue interface
Lower airways small- easily obstructed
Diaphragmatic breathing
Fewer type I (slow twitch) fibres- easy fatigue
Soft non-calcified bones- v. compliant chest wall- recession and in-drawing
Horizontal ribs- less expansion
How does children’s respiration differ (think metabolic, curve shifts etc)?
Higher metabolic rate/ oxygen consumption
(Respiratory rate higher and gradually falls)
Oxygen dissociation curve shifted left in neonates (HbF predominance)-Neonates tolerate slightly lower saturations
Immature lung vulnerable to insult
Apnoea may occur in babies
What is the circulating blood volume of a baby?
70-80ml/kg
Small loss can make a big difference
Circulation changes from in utero to ex-utero: what can remain open?
PDAs/PFO may remain open for several months
SV ..?.. with size
INCREASES
HR higher and graduallly falls
What happens to SVR from birth?
It progressively rises
- BP lower & rises
- Special cuffs/charts needed for different ages
Falling BP is a late sign in children how does this contrast to adults?
Relatively maintained compared to adults
What does bradycardia (<60) indicate?
Life threatening pathology (but may be seen in anorexia)
Manage as arrest if no response/poor perfusion
What does it mean for calculations that there is a huge variation in shape and size of children?
Calculations are done by weight/age
Why are children more prone to rapid heat loss/hypothermia?
Large SA:weight ratio
Why are babies more susceptible to infections?
Immature immune system at birth
If VIW causes a deteriation in a child what action should be taken?
Increase O2
Nebulised salbutamol & oral steroids
Senior advice:
- IV access + saline bolus
- Check bloods (FBC/CRP)
- Capillary or venous gas & CXR
- Stop feeds & start IV fluids
- Closer monitoring in HDU
What is an ISS?
Injury severity score
> 15 generally indicates a pretty significant injury that normally requires intervention
Why do children get injured?
Interaction between:
Stage of development
(Anatomical, behavioural, locomotor, physiological, psychological)
Their environment
Those around them
Think about:
Audio-visual cues, written warnings, climbing, inquisitive nature, playing, risky behaviour
Why do children injure differently?
- Different anatomical features & different physiological & psychological responses to injury
- Different spectrum of injury patterns
- Not all children are the same (neonates—adolescents)
Does the skeleton deform rather than break?
Yes-soft, springy
Incompletely calcified
Provides less protection for vital organs
Organs packed in a smaller space how can this relate to damage in an injury?
Less elastic connective tissue
- Shearing and de-gloving
Crowding of poorly protected vital organs
- Liver, spleen, bladder are intra-abdominal
- Single impact injure multiple organs
Organs packed in a smaller space how can this relate to damage in an injury?
Less elastic connective tissue
- Shearing and de-gloving
Crowding of poorly protected vital organs
- Liver, spleen, bladder are intra-abdominal
- Single impact injure multiple organs
How does children’s metabolism differ to adults in relation to coping with injury?
Thermoregulation
- Little brown fat and immature shivering
- Pokilothermic
- Environmental considerations e.g. RTCs
Hypoglycaemia
- Little glycogen stored in liver
- Exacerbated by hypothermia and vice versa
- Develops quickly in sick children
What injury patterns present?
- Waddell’s triad
- SCIWORA (spinal cord injury w/o radiological abnormality)
- Lap belt syndrome
What does ATOMFC stand for (for trauma primary survey)?
Airway obstruction
Tension pneumothorax
Open chest wound
Massive haemothorax
Flail chest
Cardiac tamponade
How is a fracture dealt with in A&E?
- Analgesia
- Hx
- Consider mechanism
- Examine all of joint-Don’t start with sore bit
- Distraction
What are some common fractures seen?
- Buckle fracture of distal radius (tis a wee bone bend)-stable fracture-splint
- Supracondylar fractures
- Greenstick fractures
- Clavicle fracture
- Toddler’s fracture of tibia-generally analgesia
- Growth plate injuries-some can cause growth arrest-need surgical intervention
What classification system is used for growth plate injuries?
Salter Harris Classification
What is used for wounds in children?
- Tissue glue
- LAT gel
- Theatre & sedation
How is a burn/scald dealt with?
- First aid-run under water
- Chemical burns-irrigate
- COBIS-guidance
- Functional
- Plastics
What should be considered in a head injury?
- NICE guidelines
- NAI
- Concussion-ACORN (advice)
- Sport-Headway
How should drowning cases be managed?
Hx is important
Hypothermia
Supportive care-ECMO
