Chapter 11 Structured approach to seriously injured child

Question 1

How to you tilt a pt to get a pat slide under them when worried about c-spine or other injuries?

Answer 1

20 degree tilt

Question 2

What is the dose of tranexamic acid?

Answer 2

15mg/kg IV/IO

Question 3

What is the bolus dose of warmed saline or warmed blood in trauma?

Answer 3

5 - 10ml/kg

Question 4

In trauma, what is your goal for platelet levels?

Answer 4

> 100 x 10>9

Question 5

In trauma what is your goal for fibrinogen levels and what can you give to increase it?

Answer 5

> 1g/L
Give cryoprecipitate

Question 6

What is your goal for calcium levels in trauma?

Answer 6

> 1mmol/L

Question 7

Why is a nasogastric tube important in major trauma?

Answer 7

Children easily develop distended abdomens and this can splint the diaphgram

Question 8

Why is an IDC important in trauma?

Answer 8

To monitor fluid status. Though avoid IDC unless the child is critically unwell. Risk of urethral stricture formation.

Question 9

Why is it important to prevent hypothermia in trauma?

Answer 9

Cause coagulopathy
Warm fluids
Cover patient

Question 10

What is the target urine output in a child?

Answer 10

1-2 ml/kg/hr

Question 11

If there has been an electrical burn or crush injury, what should the urine output be?

Answer 11

2-3ml/kg/hr

Question 12

High urine output often indicates excessive fluids, but in a head injured child, what else can cause a high urine output?

Answer 12

Diabetic insipidus.
Can develop a few hour after head injury

Question 13

What is the ACCEPT acronym?

Answer 13

Assessment
Control
Communication
Evaluation
Preparation and packaging
Transportation

Question 14

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?

Answer 14

ATMIST(ER)

Age/sex
Time of incident
Mechanism of injury
Injuries suspected
Signs
Treatment
ETA
Requirements e.g specialities

Question 15

Following the Manchester Arena Attack in 2017 what recommendations were made?

Answer 15

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

Question 16

Approach to transferring a child to a tertiary centre?

Answer 16

SCRUMP

Shared assessment
Clinical Isolation
Resource Limitation
Unfamiliar equipment
Movement and safety
Physical and physiological changes