Chapter 11 Structured approach to seriously injured child Flashcards
How to you tilt a pt to get a pat slide under them when worried about c-spine or other injuries?
20 degree tilt
What is the dose of tranexamic acid?
15mg/kg IV/IO
What is the bolus dose of warmed saline or warmed blood in trauma?
5 - 10ml/kg
In trauma, what is your goal for platelet levels?
> 100 x 10>9
In trauma what is your goal for fibrinogen levels and what can you give to increase it?
> 1g/L
Give cryoprecipitate
What is your goal for calcium levels in trauma?
> 1mmol/L
Why is a nasogastric tube important in major trauma?
Children easily develop distended abdomens and this can splint the diaphgram
Why is an IDC important in trauma?
To monitor fluid status. Though avoid IDC unless the child is critically unwell. Risk of urethral stricture formation.
Why is it important to prevent hypothermia in trauma?
Cause coagulopathy
Warm fluids
Cover patient
What is the target urine output in a child?
1-2 ml/kg/hr
If there has been an electrical burn or crush injury, what should the urine output be?
2-3ml/kg/hr
High urine output often indicates excessive fluids, but in a head injured child, what else can cause a high urine output?
Diabetic insipidus.
Can develop a few hour after head injury
What is the ACCEPT acronym?
Assessment
Control
Communication
Evaluation
Preparation and packaging
Transportation
You pick up the red phone in Resus and it is a paediatric trauma. How would you receive this call and what information would you take?
ATMIST(ER)
Age/sex
Time of incident
Mechanism of injury
Injuries suspected
Signs
Treatment
ETA
Requirements e.g specialities
Following the Manchester Arena Attack in 2017 what recommendations were made?
Casualties may present prior to the declaration of the incident
Re-triage of casualties on arrival
Children don’t carry ID so may be difficult. Keep them with parents
Check tourniquets!
Whole body CT for blast injuries!
Abx for penetrating inj
BBV need Vaccinations and PEP
Carefully assess eye injuries in low GCS patients
Forensic investigations is required in terrorist incidents all FB should be kept and labelled
Significant psychological impact on staff of all levels
Simulation and table-top exercises are essential for service planning
Approach to transferring a child to a tertiary centre?
SCRUMP
Shared assessment
Clinical Isolation
Resource Limitation
Unfamiliar equipment
Movement and safety
Physical and physiological changes
