Chapter15 The child wih injuries to the extemities or spine

Question 1

How long can an amputated limb/digit be salvageable for?

Answer 1

8 hours at room temp
18 hours if cooled

Question 2

How long can an amputated limb/digit be salvageable for?

Answer 2

8 hours at room temp
18 hours if cooled

Question 3

If a limb cannot be reimplanted (too dirty too old) can it still be useful?

Answer 3

Yes for bone or skin grafts

Question 4

What are the signs of vascular injury?

Answer 4

Abnormal pulses
Impaired capillary return
Decreased sensation
Rapidly expanding haematoma
Bruit

Question 5

What type of injuries are most at risk for compartment syndrome?

Answer 5

Crush injuries

Question 6

What are the signs of compartment syndrome?

Answer 6

Pain, accentuated by passive stretching of involved muscles
Decreased sensation
Swelling
Pallor of limb
Paralysis
Pulselessness

Question 7

Why is it preferable to stop bleeding from open fractures with direct pressure as opposed to ligation?

Answer 7

Ligation risks injury to nerves

Question 8

What is the clinical criteria for clearing a cervical spine?

Answer 8

No midline tenderness on direct palpation
No focal neurological deficits
Normal alertness
No intoxication
No painful distracting injury

Question 9

How do you assess for retropharyngeal swelling (can be present with cervical spine fracture) on a lateral xray?

Answer 9

At the inferior part of the body of C3 the pre-vertebral distance should be 1/3 of the width of the body of C2
Distance is increased in crying child

Question 10

Where in the spine is a spinal cord injury without radiographic abnormality (SCIWORA) most likely to occur?

Answer 10

Cerivcal spine due to it’s increased mobility and the the cervical cord is most susceptible to injury

Question 11

A child in unconscious, the C-spine CT is normal , can you clear the C-spine?

Answer 11

Depends. In the multiply injured patient they should remain immobilised until assessment can be carried out or have had an MRI