ATLS-pediatric trauma Flashcards
Why is it that multisystem trauma is the rule rather than the exception in children?
Small stature and physical characteristics
Why are bone fractures in children more significant than the same in an adult?
bones are much more pliable, and thus more energy was required
Why are thermal issues more severe in children?
Higher body surface area to volume
What are the four clinical criteria to justify the use of radiation in children?
- Information cannot be obtained another way
- Info will change clinical management
- Obtained at lowest radiation
- will not delay care
How do you determine the appropriate dosages and equipment sizes for children?
Use the broselow tape
How do you maintain inline stabilization for infants and children? Why this way?
midface should be aligned with the backboard
Occiput is relatively larger in chldren
What is the equation for determining the proper ET tube depth?
3x the tube size gives the length in cm
Why should you not insert an oropharyngeal airway and rotate 180 degrees in children?
Soft palate is much more delicate
What part of the airway is the smallest in children?
cricoid ring
How do you determine the correct radius of the ET tube for children?
Compare to pinky
What effect on the heart does intubation have? What happens this this effect in children?
Stimulation of the airway increases vagal tone, which is increased in children
What is the most common cause of bradycardia/arrest in children?
Hypoxia
Who may need pretreatment with atropine prior to intubation?
Infants to prevent vagal tone increase
What is the dose of etomidate in children? (normo and hypovolemic)
- 3 mg/kg if normovolemia
0. 1 if hypovolemic
What is the dose of succ in children? (2)
2 mg/kg if less than 10 kg,
1 mg/kg if over
Should nasotracheal intubation be used in children? Explain.
No, because will damage tissue and be harder d/t more anterior airway
What are the components of the DOPE mnemonic for common causes of deterioration in intubated patients?
Dislodgement
Obstruction
PTX
Equipment failure
How easy is it to dislodge an ET tube in a child? What is the significance of this?
Very easy, so reassess frequently, especially after moving patient
What is the alternative to intubation in an infant or small child?
Needle cricothyroidotomy
The use of a pediatric bag-valve mask is indicated for children under what weight (in kg)?
30
What is the most common cause of acidosis in a ventilated child?
Inadequate ventilation
Where is the site for a chest tube in children? Needle decompression?
Chest Tube = Same as for adults
Needle = 3rd intercostal midclavicular
SBP is maintained until very late in pediatric shock. What, then, are the sign used to detect shock?
tachycardia and poor peripheral perfusion
Narrow pulse pressure
What is the substitute for clammy skin in kids?
Skin mottling
What is the equation for mean SBP in children? Mean DBP?
SBP = 90 +2*(age in years) DBP = 70+2*(age in years)
What can be used to estimate a child’s weight? (3)
- Ask caregiver
- Broselow tape
- (2*age)+10
How much blood does an infant have to lose to manifest hypotension?
30-45%
What is the next best thing to IV in the AC for children?
IO in the leg
Can you use an IO in a bone with a fracture?
No
What is the bolus rate for fluids and blood respectively in children?
Fluids = 20 ml/kg Blood = 10 ml/kg
Why are children more prone to developing a tension PTX?
Increased mobility of the mediastinum
True or false: pneumomediastinum is generally benign
True
Why is gastric distention of the abdomen common in children and what can be done to relieve this for an adequate exam?
Crying causes air swallowing
OG tube
Which is preferred in children: NG or OG tube?
OG
Why should the bladder be fully decompressed prior to evaluating the abdomen?
If full, may elicit discomfort and confuse exam findings
Can a FAST exam detect solid organ injury
no
True or false: + blood on a DPL in a child will lead immediately to an operative intervention
False–much more dependent on clinical status of the patient
Why should only the surgeon who is to operate on a child be the one to perform a DPL?
Because it may interfere with subsequent abdominal examinations
What is unique about the skull and thus cranial injuries in children?
Sutures are not fused, so can hold more blood or masses. Thus bulging fontanelles need to be addressed
True or false: all seizure activity in trauma patients require a head CTq
True
What is the significance of vomiting after head injury in children?
1 time, no big deal. But if persistent, then evaulate
When is neurosurgical consultation necessary in children, besides CT scan findings? (2)
- GCS less than 8 or motor scores of less than 2
- Multiple injuries associated with head injury with hemodynamic instabilities
What are the scores and meaning for the verbal part of the pediatric GCS?
5 = appropriate words or social smile, fixes and follows 4 = Cries, but unconsolable 3 = Persistently irritable 2 = restless, agitated 1 = none
What is and how common is pseudosubluxation in children?
The appearance of subluxing vertebral bodies (cervical) that can be normally present in in up to 40% of children
How can you differentiate true subluxation from pseudosubluxation in a child?
Have the child lie on a 1 inch thick mat beneath their entire body except the head. True subluxation will not disappear with this maneuver, and warrants more testing
How common are “spinal cord injury without radiographic abnormalities” (SCIWORA) in children compared to adults?
More
How much blood is lost in bone fractures in children compared to adults?
Less–should search for other causes of hemodynamic instability
