approach to trauma in pediatric patient

Question 1

pathophys

Answer 1

multisystem injury is the rule instead of exception. trauma induces a systemic neuroendocrine response resulting in the release of inflammatory mediators, causing hypo-volemia, hypotension, hypothermia, and hypo-oxygenation. Look for peripheral signs first (increased cap refill, cool skin) and then change in BP.

Question 2

anatomic characteristics of children that lead to increased susceptibility to injury

Answer 2

• skeletal and ligamentous structures have increased flexibility, which results in greater transmission of force to internal organs.
• weak neck muscles and higher center of gravity lead to more head injuries
• less protective muscle and subcu tissue over internal organs means viscera are closer to the surface and can be bruised

Question 3

physiologic characteristics of children that lead to increased susceptibility to injury

Answer 3

• underlying heart disease rarely results in morbidity in children.
• hypoxia and respiratory failure are increasingly likely in children
• high body surface area to weigh ratio predisposes children to hypothermia, which may complicate shock and worsen acidosis if its not corrected.

Question 4

what to give iv

Answer 4

isotonic fulid, NS or ringers, at 20 ml/kg up to 80 ml/kg after that consider blood or other crystalloid. after initial bolus if stable start fluid replacement 100 ml/kg for first 10 kg, 50 ml/kg for next 10 kg, and 20 ml/mg for each kg over 20. 40 or more kg get adult fluid maintenance of 2000 ml over 24 hours.

Question 5

radiology

Answer 5

c-spine, chest and pelvis first.

Question 6

causes of abdominal trauma

Answer 6

falls, bike accident, seatbelt, kick etc

Question 7

symptoms of abdominal trauma

Answer 7

diffuse abdominal pain, vomitting, distention, sudden collapse if splenic injury

Question 8

exam for abdominal trauma

Answer 8

peritoneal signs, decreased bowel sounds, rigid abdomen, melena, look for bruising along the seat belt or tire tracks

Question 9

management of abdominal trauma

Answer 9

order plain film, may see air/fluid level in loops of bowel, hematoma shadow, splenic shadow or narrowing of lumen in bowel.

Question 10

c-spine trauma

Answer 10

to stabalize, may need to roll under shoulders and pad under head to place head in neutral position. most commonin infants and children is C1, C1/C2 or C5-C7 in school age (>8 same guidelines as adult).

Question 11

symptoms of Head/Cspine injury

Answer 11

vomiting, irritability, headache, visual changes, amnesia, altered level of consciousness, seizures, superficial contusion, all the way to respiratory arrest

Question 12

Exam for head/cspine injury

Answer 12

full exam including neurological and fundiscopic (can see retianl hemorrhages). Neuro exam may reveal altered level of cosciousness, alterations in tone or focal abnormalities.

Question 13

grade 1 head injury

Answer 13

transient confusion, No LOC, post traum. amnesia

Question 14

grade 2 injury

Answer 14

transient confusion No LOC, post traum amnesia > 15 miin

Question 15

grade 3 injury

Answer 15

continued confusion, any LOC, post traum amnesia >12 hours