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A1 > ATLS-pediatric trauma > Flashcards

ATLS-pediatric trauma Flashcards

1
Q

Why is it that multisystem trauma is the rule rather than the exception in children?

A

Small stature and physical characteristics

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2
Q

Why are bone fractures in children more significant than the same in an adult?

A

bones are much more pliable, and thus more energy was required

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3
Q

Why are thermal issues more severe in children?

A

Higher body surface area to volume

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4
Q

What are the four clinical criteria to justify the use of radiation in children?

A
  • Information cannot be obtained another way
  • Info will change clinical management
  • Obtained at lowest radiation
  • will not delay care
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5
Q

How do you determine the appropriate dosages and equipment sizes for children?

A

Use the broselow tape

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6
Q

How do you maintain inline stabilization for infants and children? Why this way?

A

midface should be aligned with the backboard

Occiput is relatively larger in chldren

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7
Q

What is the equation for determining the proper ET tube depth?

A

3x the tube size gives the length in cm

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8
Q

Why should you not insert an oropharyngeal airway and rotate 180 degrees in children?

A

Soft palate is much more delicate

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9
Q

What part of the airway is the smallest in children?

A

cricoid ring

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10
Q

How do you determine the correct radius of the ET tube for children?

A

Compare to pinky

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11
Q

What effect on the heart does intubation have? What happens this this effect in children?

A

Stimulation of the airway increases vagal tone, which is increased in children

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12
Q

What is the most common cause of bradycardia/arrest in children?

A

Hypoxia

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13
Q

Who may need pretreatment with atropine prior to intubation?

A

Infants to prevent vagal tone increase

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14
Q

What is the dose of etomidate in children? (normo and hypovolemic)

A
  1. 3 mg/kg if normovolemia

0. 1 if hypovolemic

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15
Q

What is the dose of succ in children? (2)

A

2 mg/kg if less than 10 kg,

1 mg/kg if over

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16
Q

Should nasotracheal intubation be used in children? Explain.

A

No, because will damage tissue and be harder d/t more anterior airway

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17
Q

What are the components of the DOPE mnemonic for common causes of deterioration in intubated patients?

A

Dislodgement
Obstruction
PTX
Equipment failure

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18
Q

How easy is it to dislodge an ET tube in a child? What is the significance of this?

A

Very easy, so reassess frequently, especially after moving patient

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19
Q

What is the alternative to intubation in an infant or small child?

A

Needle cricothyroidotomy

20
Q

The use of a pediatric bag-valve mask is indicated for children under what weight (in kg)?

A

30

21
Q

What is the most common cause of acidosis in a ventilated child?

A

Inadequate ventilation

22
Q

Where is the site for a chest tube in children? Needle decompression?

A

Chest Tube = Same as for adults

Needle = 3rd intercostal midclavicular

23
Q

SBP is maintained until very late in pediatric shock. What, then, are the sign used to detect shock?

A

tachycardia and poor peripheral perfusion

Narrow pulse pressure

24
Q

What is the substitute for clammy skin in kids?

A

Skin mottling

25
Q

What is the equation for mean SBP in children? Mean DBP?

A 
SBP = 90 +2*(age in years)
DBP = 70+2*(age in years)
26
Q

What can be used to estimate a child’s weight? (3)

A
  • Ask caregiver
  • Broselow tape
  • (2*age)+10
27
Q

How much blood does an infant have to lose to manifest hypotension?

A

30-45%

28
Q

What is the next best thing to IV in the AC for children?

A

IO in the leg

29
Q

Can you use an IO in a bone with a fracture?

A

No

30
Q

What is the bolus rate for fluids and blood respectively in children?

A 
Fluids = 20 ml/kg
Blood = 10 ml/kg
31
Q

Why are children more prone to developing a tension PTX?

A

Increased mobility of the mediastinum

32
Q

True or false: pneumomediastinum is generally benign

A

True

33
Q

Why is gastric distention of the abdomen common in children and what can be done to relieve this for an adequate exam?

A

Crying causes air swallowing

OG tube

34
Q

Which is preferred in children: NG or OG tube?

A

OG

35
Q

Why should the bladder be fully decompressed prior to evaluating the abdomen?

A

If full, may elicit discomfort and confuse exam findings

36
Q

Can a FAST exam detect solid organ injury

A

no

37
Q

True or false: + blood on a DPL in a child will lead immediately to an operative intervention

A

False–much more dependent on clinical status of the patient

38
Q

Why should only the surgeon who is to operate on a child be the one to perform a DPL?

A

Because it may interfere with subsequent abdominal examinations

39
Q

What is unique about the skull and thus cranial injuries in children?

A

Sutures are not fused, so can hold more blood or masses. Thus bulging fontanelles need to be addressed

40
Q

True or false: all seizure activity in trauma patients require a head CTq

A

True

41
Q

What is the significance of vomiting after head injury in children?

A

1 time, no big deal. But if persistent, then evaulate

42
Q

When is neurosurgical consultation necessary in children, besides CT scan findings? (2)

A
  • GCS less than 8 or motor scores of less than 2

- Multiple injuries associated with head injury with hemodynamic instabilities

43
Q

What are the scores and meaning for the verbal part of the pediatric GCS?

A 
5 = appropriate words or social smile, fixes and follows
4 = Cries, but unconsolable
3 = Persistently irritable
2 = restless, agitated
1 = none
44
Q

What is and how common is pseudosubluxation in children?

A

The appearance of subluxing vertebral bodies (cervical) that can be normally present in in up to 40% of children

45
Q

How can you differentiate true subluxation from pseudosubluxation in a child?

A

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

46
Q

How common are “spinal cord injury without radiographic abnormalities” (SCIWORA) in children compared to adults?

A

More

47
Q

How much blood is lost in bone fractures in children compared to adults?

A

Less–should search for other causes of hemodynamic instability

A1 (32 decks)

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