FINAL EXAM Flashcards
What are (8) common examples of trauma incidences in pediatrics?
Near drowning
Lawn mower accidents
Riding Accidents
Motor Vehicle Accidents
All-terrain vehicle accidents
Amish-Buggy Accidents
Burns
Dog bites
What are the major toxic effects of LA?
CV and CNS
LA crosses the BBB readily
Because of the lower/higher threshold for cardiac toxicity with bupivicaine, cardiac and CNS toxicity may occur virtually simultaneously in infants and children
Lower
What can happen if under GETA and having LA toxicity?
GETA with volatile anesthetics may obscure the signs of CNS toxicity until devastating CV effects are apparent.
CNS and CV signs of toxicity include what? 8 things?
- Circumpolar paresthesia
- Lightheadedness
- Tinnitus
- Slurred speech
- Muscle twitching
- Seizures
- Respiratory depression/arrest
- Ventricular arrhythmias/ cardiac arrest
What 3 channels does bupivacaine have a particular affinity for?
What effect does this have on resuscitative efforts?
Na
K
Ca
Makes resuscitation effort difficult after toxic dose of bupivicaine
Bupivicaine is highly bound to plasma proteins (a1- acid glycoprotein) and concentration of albumin and a1 acid glycoproteins are less/more in neonates which increases/decreases free (unbound) fraction of the LA that produces toxicity.
Less
Increased
After the accidental injection of large intravascular dose of bupivacaine, the progression from prodromal signs to CV collapse is slow and progressive. T/F?
False, it’s rapid
What is the resuscitation for toxic reactions of LA?
ABC
Patent airway, supplemental oxygen, reestablishing circulation and normal cardiac rhythm.
What can you give to terminate or prevent seizure activity?
Versed 0.05-0.2 mg/kg
Thiopental 2-3mg/kg
If they go into cardiac arrest from LA toxicity what should you give?
CARDIAC ARREST -> THINK INTRALIPIDS
Treatment of toxic reactions: Lipid sink hypothesis.
What is the mechanism of action of this mechanism?
1.5ml/kg of 20% IV lipid emulsion have shown to be effective for resuscitation of cardiac arrest due to bupivacaine toxicity.
The mechanism is not entirely understood, suspect that it binds free fractions of bupivicaine
What are the doses that can be repeated for LAST?
Yes dose can be repeated (max 3mL/kg) followe by a maintenence infusion rate of 0.25 mL/kg/min until circulation is restored.
Can propofol be used as a substitute for intralipid for resuscitation from bupivacaine Toxicity?
No
What should supportive treatment include for toxic reactions to LA?
IV fluid loading 10-0 mL/kg of isotonic crystalloid
Peripheral vasopressors (phenylephrine, norepinephrine)
Anti arrhythmic drugs
Phenytoin
ECMO
Where is the conus medullary in neonates/infants?
In neonates/infants up to 1 year it is located at L3 vs adults L1
Where is lumbar puncture for SAB in neonates/infants performed?
L4-L5 and L5-S1 to avoid going into spinal cord
Where does the tip of the SC end in the neonate?
L3
When does the tip of the SC achieve the normal adult position (L1-L2)?
1 year of age
Neonatal sacrum is narrower/wider and flatter/more pointy than in adults.
What does this do to your approach to the subarachnoid space?
Narrower and flatter
The approach to the subarachnoid space from the caudal canal is much more likely, so the needle must not be advanced deeply in neonates.
When is a caudal block contraindicated?
The presence of a deep sacral dimple may be associated with spina bifida occulta and greatly increasing the probability of dural puncture.
CSF volume as a percentage of body weight is less in infants and young children than in adults. T/F?
False, greater
Why do children require larger doses of LA for surgical anesthesia comparatively with a subarachnoid block in infants and young children?
The fact that CSF as a percentage of body weight is greater in young children than in adults.
The CSF turnover rate is considerably greater in infants and children, accounting in part for the much briefer duration of SAB agent compared with adults. T/F?
True
Anatomic differences necessitate meticulous attention to detail to achieve successful and uncomplicated spinal and epidural anesthesia. T/F?
True
In contrast to Older children and adults, subarachnoid and epidural blockade in infants and small children is characterized by ____________ __________, even when the level of the block reaches the upper thoracic dermatomes.
Hemodynamic stability
In infants the sympathetic/parasympathetic NS is stronger than the parasympathetic/sympathetic therefore, the HR appears to attenuated and clinically significant blood pressure changes do/do not occur in young infants after a SAB.
Parasympathetic
Sympathetic
Do not
Position of patient for caudal epidural
Lateral decubitus position with spine and shoulder in neutral curvature
What do you palate before performing caudal epidural?
Palate the coronau of sacral hiatus.
What are the cornau of the sacral hiatus?
Two bony ridges that are palpated, about 0.5-1cm apart and are often found just at the beginning of the crease of the buttocks
Where is the appropriate insertion spot in caudal epidural anesthesia?
The appropriate insertion spot is slightly more caudal form the palpated sacral corni
Caudal Epidural: how to perform?
Prep site with iodine, chlorohexadine and alcohol pads (wiped toward the buttocks)
Have prepared 22G IV catheter with a pig tail and LA filled syringe readily available
Done sterile gloves, palpated the injection site and insert the needle bevel facing downward- initially directed cephalad at a 45 degree angle
Needle advances through the skin until it “pops through the sacrococcygeal ligament into caudal canal, which is continguous with epidural space.
As needle is advanced the angle of the needle should be decreased and nearly parallel to the plane of the child’s back
IV catheter stays in place, while the needle is removed. The pigtail - syringe filled with LA will be attached
Once negative aspiration for both blood or CSF is confirmed test does of LA is administered
If neither hemodynamic nor ECG changes are evident after the test dose, the remainder of the dose of LA for a single shot caudal anesthesia should be slowly injected wth intermittent aspiration
Intraosseous injection of LA results in v rapid uptake (similar to direct IV injection)
Remove IV catheter, wipe off the size and place bandaid over it.
What do you do if encounter bone when doing caudal epidural anesthesia?
If bone is encountered before sacrococcygeal ligament, needle should be withdrawn several millimeters, the angle with the skin decreased (~30 degrees) and again gently advanced until ligament is pierced
The drug dose required for epidural blockade to a given dermatomal level depends on what?
The volume NOT CONCENTRATION of the LA and volume of the epidural space, which may change with age
The concentration of the LA should be based on what?
The desired density of the block and the risk of toxicity
Should the block be more dense/less dense for post op analgesia?
Less dense
Should block be more dense or less dense for intr op anesthesia?
More dense
MM
Where does the SC end in neonate?
Ends at the lower border of L3
MM
A neonate is underlying a surgical procedure with the use of a spinal blockade. What sign would indicate a “high” or “total” spinal?
Decreasing oxygen saturation is the earliest sign of a high or total spinal in the neonate
A high or total spinal, produced either with a primary spinal technique or secondary to an attempted epidural, presents as respiratory insufficiency rather than hypotension owning to a relatively immature sympathetic nervous system in the neonate.
Which an immature sympathetic nervous system, the cardiovascularparameters areremarkably stable in the neonate with a high or total spinal
MM
What is the max dose of 0.5% bupivacaine that should be sued for pediatric caudal anesthesia?
Bupivacaine (0.25%) at a volume of 1ml/kg up to a maximum of 25mL can provide 3-6 hours of anesthesia for surgical procedures below the level of the diaphragm
MM
What is the appropriate volume for pediatric epidural blood patch?
In the child who is awake, the practitioner should stop the blood infusion once th child feels discomfort of pressure in the back
In the anesthetized patient, no more than 0.3mL/kg of blood should be injected into the epidural space.
A baby’s head can weigh what percent of its total body weight?
1/4th of its total body weight
Why can the baby’s head fling out of control?
Because the neck muscles are weak and any violent shake will cause the head to fling out of control, because the baby’s head weighs 1/4th of its total body weight.
The impact of shaken baby syndrome can be up to 30 times the force of gravity and cause permanent or fatal damage to the baby. T/F?
True
Because the damage form shaken baby syndrome is external, signs of danger can be seen easily. T/F?
False, damage is internal, signs of danger may not be seen until its too late.
Blood vessels that lea from the brain to the dura membrane are most susceptible to tearing since the subdural space between the brain and the skull is greater for for babies. T/F?
True
What happens when the nerves inside the brain sever from shaken baby syndrome?
The brain will swell, cutting off oxygen tot the brain in surviving babies- blindness and brain damage may also occur.
What is located in the brain stem and what happens if it is severed or damaged?
Vital sensors are located in the brain stem and if severed or damaged baby will experience respiratory problems and vomiting.
What nerve is often damaged in shaken baby syndrome and can cause retinal bleeding?
Optic nerve
Retinal hemorrhage (unilateral) has an incidence of ______% in SBS; if bilateral the incidence increases up to _____%.
50-80%
90%
What are s/sx of cerebral injury form SBS?
"Not acting right" Poor feeding Vomiting Irritability Lethargy Seizure Apnea Altered LOC Visual impairment (retinal hemorrhage) Unexplained infant death
The majority of patients who survive severe shaking will have some form of neurologic or mental disability, such as CP or mental retardation requiring lifelong medical care. T/F?
True
Definition of physical abuse?
Physical abuse is defined as physical, mental injury or sexual abuse of a child under the age of 18 years by a person who is responsible for the child’s welfare.
Definition of neglect?
Occurs when a care provider responsible for the child either deliberately or by extraordinary inattentiveness permits a child to suffer, or fails to provide conditions generally deemed essential for developing a child’s physical, intellectual or emotional capacities.
Children who are at risk for non accidental trauma?
Children born with physical or developmental disabilities
Children born to single parents who are themselves younger, lesser- educated with less/no prenatal care and children with a family history of violence or other abused siblings.
What age of children are at the highest risk for maltreatment and subsequent mortality?
3 years and younger
What does bruising form physical abuse look like?
Tends to be bilateral, widespread and on soft tissue areas (e.g. Inner thighs, axillary regions) that do not usually come in contact with hard surfaces on falling.
Multiple bruises with different colors, belt whips, finger and hand marks, burns from cigarette butts or hot iron, multiple fractures in different healing stages are s/s of abuse. T/F
True
Abuse by immersion of children in hot fluids presents how?
Usually present with bilateral burns or equal severity usually of palms or lower half of the body with sparing of the flexor creases because the child would be pulling up their legs to avoid the hot fluid
What should you do if you suspect a child is being abused?
Consult services of DCS and SW.
What is the top 5-6 leading causes of injury in children <1?
1) Unintentional suffocation
2) Homicide unspecified
3) Homicide specified
4) Unintentional MV Traffic
5) Undetermined suffocation
6) Unintentional drowning
What are the top 5 leading causes for children 1-4 years old?
1) Unintentional drowning
2) Unintentional MV traffic
3) Homicide unspecified
4) Unintentional suffocation
5) Unintentional fire/burn
What are the top 5 causes for children 5-9 leading cause of death?
1) unintentional MV traffic
2) Unintentional drowning
3) unintentional fire/burn
4) Homicide/firearm
5) unintentional other land transport
What are the top 5 leading causes of death for children 10-14?
1) unintentional MV traffic
2) suicide suffocation
3) suicide firearm
4) Homicide firearm
5) Unintentional drowning
What are the top 5 leading causes of death for children 15-24?
1) Unintentional MV traffic
2) Homicide fire arm
3) Unintentional poisoning
4) Suicide firearm
5) suicide Suffocation
__ remain the leading cause of DEATH and DISABILITY in the pediatric population.
Injuries
Up to __% of polytrauma patients die as a result of CIRCULATORY SHOCK from acute blood loss.
40%
Besides surgical control of hemorrhage, what is crucial for survival for polytrauma victims?
Adequate volume resuscitation with blood products and fluids
What is the MAJOR threat to children in the United States?
Vehicular trauma
What is the most common cause of death from injury for victims of all ages?
Traumatic brain injury
The initial management and definitive care of the child with traumatic head injury is focused on __ __ __ to minimize extension of injury and maximize recovery of the damaged neurons while simultaneously managing extracranial injury so as to assure return to full functionality.
Optimizing cerebral perfusion
What are the primary goals of management of pediatric trauma patients?
1) Delivery of oxygen
2) appropriate ventilation
3) perfusion to vital organs
4) maintenance of normothermia to mild hypothermia
5) assurance of renal function
6) neurologic stability
7) correction of coagulopathies
8) avoidance of overhydration
9) meticulous management of metabolic demands
What information is obtained and is called as “report from the field”?
Age
Sex
Mechanism of injury (MVA vs fall)
Obvious injuries
Airway management (spontaneous vs. intubation
Vital signs
IV access
Loss of consciousness
ETA
How do you prepare for the trauma patient coming including estimated weight?
Estimated weight
Blood availability
RSI and rescue drugs
Suction
Anesthesia machine check
Blades/ETT
Airway cart/fiberoptic bronchoscope/LMA
Rapid infuser/IV fluids
RSI Medications for Peds Trauma
ATROPINE
10-20 mcg/kg (min 0.1 mg)
RSI Medications for Peds Trauma
GLYCOPYRROLATE
10 mcg/kg
RSI Medications for Peds Trauma
MIDAZOLAM
0.05-1 mg/kg
RSI Medications for Peds Trauma
FENTANYL
1-2 mcg/kg
RSI Medications for Peds Trauma
LIDOCAINE
1-1.5 mg/kg
RSI Medications for Peds Trauma
PROPOFOL
2-4 mg/kg
RSI Medications for Peds Trauma
KETAMINE
1-2 mg/kg
RSI Medications for Peds Trauma
THIOPENTAL
4-6 mg/kg
RSI Medications for Peds Trauma
ETOMIDATE
0.3 mg/kg
RSI Medications for Peds Trauma
ROCURONIUM
1.2 mg/kg
RSI Medications for Peds Trauma
SUCCINYLCHOLINE
1.5-2 mg/kg
Resuscitation Drugs Dose
EPINEPHRINE
1 mcg/kg to treat hypotension
10 mcg/kg IV for cardiac arrest
Resuscitation Drugs Dose
ATROPINE
20 mcg/kg IV for symptomatic bradycardia
Max dose for a child: 1 mg
Max dose for adolescent: 2 mg
Resuscitation Drugs Dose
BICARBONATE
1-2 meq/kg IV (guided by blood gas analysis results)
Resuscitation Drugs Dose
CALCIUM CHLORIDE
10-20 mg/kg IV (preferred central line, slowly)
Resuscitation Drugs Dose
CALCIUM GLUCONATE
30-60 mg/kg IV (PIV is ok)
Resuscitation Drugs Dose
LIDOCAINE
1 mg/kg IV,
Followed by 20-50 mcg/kg/MIN infusion
Resuscitation Drugs Dose
ADENOSINE
100 mcg/kg RAPID IV bolus and flush (max: 6 mg)
Second dose: 200 mcg/kg and flush (max: 12 mg)
Resuscitation Drugs Dose
AMIODARONE
5 mg/kg IV (max: 300 mg) for VF and VT
Resuscitation Drugs Dose
PROCAINAMIDE
5-15 mg/kg IV loading over 30-60 min
Then 20-80 mcg/kg/MIN infusion
***ECG required
Resuscitation Drugs Dose
MAGNESIUM
25-50 mg/kg IV (max: 2 gm)
For Torsades de pointes
Vasoactive drugs VIA pump dose
DOPAMINE
1-20 mcg/kg/min
Vasoactive drugs VIA pump dose
DOBUTAMINE
1-20 mcg/kg/min
Vasoactive drugs VIA pump dose
EPINEPHRINE
0.1-1 mcg/kg/min
Vasoactive drugs VIA pump dose
ISOPROTERENOL
0.1-1 mcg/kg/min
Vasoactive drugs VIA pump dose
NOREPINEPHRINE
0.1-1 mcg/kg/min
Vasoactive drugs VIA pump dose
PHENYLEPHRINE
0.1-1 mcg/kg/min
Vasoactive drugs VIA pump dose
MILRINONE
50-100 mcg/kg loading
Then
0.5-1 mcg/kg/min
Vasoactive drugs VIA pump dose
NITROPRUSSIDE
1-10 mcg/kg/min
Vasoactive drugs VIA pump dose
NITROGLYCERINE
1-10 mcg/kg/min
Vasoactive drugs VIA pump dose
PROSTAGLANDIN E1
0.05 mcg/kg/min
Vasoactive drugs VIA pump dose
VASOPRESSIN
0.0001- 0.0005 units/kg/min
4 ml/kg of PRBCs increases hemoglobin by?
1 g/dL
5-10 ml/kg increases platelet count by?
50,000-100,000/mm^3
10-15 ml/kg of FFB increases the factor level by?
15-20%
1-2 units/kg of cryo increases fibrinogen by?
60-100 mg/dL
The recognition of the lethal triad of __, __, and __ has led to the concepts of damage control surgery and resuscitation.
Coagulopathy (decreased coagulation)
Acidosis (Increased lactic acid)
Hypothermia (decreased heart performance)
If there are signs of bleeding and significant hemostasis challenge in a surgical procedure, what is the level of platelets required?
30,000-50,000 mm ^3
Platelets should be filtered only by large pore filters, greater than or equal to __ micrometer
150
Platelets should NOT be __ or placed in a cooler with ice.
Refrigerated
What contains all the clotting factors and regulatory proteins at approximately the native concentration?
Fresh Frozen Plasma
Current available evidence suggest that only massively transfused patients could potentially benefit from a higher __:___ ratio.
1:1 ratio of FFP:RBC
However, INCREASED/DECREASED FFP transfusions to non-massively transfused patients were associated with __ and __.
INCREASED FFP
ARDS (trend towards increased mortality)
TRALI (increased risk of developing transfusion related to ALI
Rapid administration of FFP can cause __ __.
Citrate toxicity
Citrate chelates __ and __ and is added to FFP and platelets to prevent clotting during storage in the blood blank.
Calcium and Magnesium
Remaining citrate in blood production during massive blood transfusion will cause __.
Hypocalcemia
Signs and symptoms of hypocalcemia intra-op may include __ & __.
Hypotension and arrhythmias
Citrate intoxication may be more likely in the setting of __, liver disease/transplantation (citrate is metabolized by the liver), and is more likely in __ patients.
Hypothermia
Pediatric patients
What two medications are given to treat citrate toxicity?
Ca gluconate 30-60 mg/kg IV
Ca chloride 10-20 mg/kg IV
What blood product contains 20-50% of factor VIII from the original unit, von Willebran factor (vWF), fibrinogen (approx 250 mg?
Cryoprecipitate
When is cryoprecipitate indicated?
Treatment of
Factor XIII deficiency
Dysfibrinogenemia
Hypofibrinogenemia
How do you calculate the maximal allowable blood loss?
MABL = EBV x (Hct (before blood loss) - maHct( minimum accepted Hct)/ Hct
How do you determine the Volume of PRBCS to be transfused?
EBV (ml) x (desired Hct- present low Hct/Hct of PRBCS (~60)
What balances oxygen supply and demand and is dependent on number of factors including oxygen content of blood, CO, regional distribution, and metabolic needs?
Hematocrit
A child with SEVERE pulmonary disease or CYANOTIC CHD requires a LESSER/GREATER hematocrit than a healthy child?
GREATER
Pre-term infants may require less hematocrit to prevent apnea, reduce cardiac and respiratory work, and possibly improve neurologic outcomes. True or False.
False, greater hematocrit
If there is a little potential for post op bleeding, what is the acceptable level of Hct in healthy infants up to about 3 mos? And in older, otherwise healthy patients?
20-25%
20%
How do you asses the adequacy of your volume replacement?
Observing the operative field (to estimate blood loss)
Monitor vital signs
Hematocrit
Urine output
CVP
The risk of spine injury in the pediatric patient is decreased whenever the child is subjected to INERTIAL FORCE FROM FALLS and CHAOTIC ROTARY FORCES associated with motor vehicle crashes. True or False.
False. INCREASED
Any child with suspected neck injury should have __ __ __ implemented.
Cervical spine precautions (collar device immobilization)
In cervical spine patients, __ __ should always be maintained when airway manipulation is attempted.
In-line stabilization
Intubation of a child with cervical fracture may require up to ___ individuals. And what are the responsibilities of each individuals?
One to provide in-line stabilization
Second to perform intubation
Third person to perform cricoid pressure and either hold ETT or retract cheek for individual performing intubation
Fourth to administer drugs
What is the initial management of the severe brain injury be focused on?
The actual pathophysiolofic process that occurred at the point of impact
What scale is used for adults and peds for initial and ongoing assessments of severity of CNS injury?
Glasgow Coma Scale for adults
Modified Glasgow Coma Scale for Peds
Regardless of whether the brain injury is a result of trauma or secondary to global hypoxia, there is an immediate disruption of the integrity of BBB and results in what two things?
cerebral edema
Diminished neuronal oxygenation
According to the GCS (modified for PEDS) What is the EYE opening response (4-1) for < 1 year?
4: Spontaneous
3: To shout
2: Pain
1: None
According to the GCS (modified for PEDS) What is the VERBAL response (5-1) for 0-2 years?
5: Babbles, coos appropriately
4: Cries but is inconsolable
3: Persistent crying or screaming in pain
2: Grunts or moans to pain
1: None
According to the GCS (modified for PEDS) What is the MOTOR response (6-1) for < 1 year?
6: spontaneous
5: localizes pain
4: withdraws pain
3: abnormal flexion to pain (decorticating)
2: abnormal extension (decerebrate)
1: None
Children with head trauma have a lot of neurologic abnormalities at at that time of evaluation. True or False.
False, minimal neurologic abnormalities
What two things may progressively develop in pediatric head trauma patients?
Increased ICP
Neurologic deficits
Increased ICP and Neurologic deficits occur slowly because brain injuries occur in two stages. True or False.
True
What kind of insult occurs at the time of impact resulting from the biomechanical forces that disrupts the cranium, neural tissue, and vasculature.
Primary insult
What insult is occurring when the parenchyma damage caused by pathologic sequelae subsequent to the primary insult?
Secondary insult?
Secondary insult can result from?
Hypotension
Hypoxia
Cerebral edema
intracranial HTN/ICP
Ventilation of children with cerebral injury should maintain the PaCO2 between __ and __ mm Hg.
35-40
Routine mild hyperventilation (PaCO2 30-35 mmHg) is to be AVOIDED. True or False.
True
Data suggest that hyperventilation, even during “rescue” from acute intracranial HTN, preferentially decreases blood flow to the penumbra of injured neurons surrounding the area of acute brain injury, thereby actually worsening flow to are most in need of perfusion. True or false.
True
Management of brain injury must also address excessive elaboration of excitatory neurotransmitters that are a common characteristics of neuronal damage. True or False.
True
Immediate administration of __ and __ titrate to an appropriate level of analgesia and sedation -> “calming the brain”
opioids and benzos
Seizure prophylaxis (phenytoin, phenobarbital) in pediatric trauma patients is associated with increased mortality. True or false.
False -> DECREASED
__ skull fractures should be considered when caring for children with altered mental status, seizures or associated trauma requiring injury.
Basilar skull fractures
What are some findings in basillar skull fractures?
Periorbital ecchymoses (raccoon eyes)
Retroauricular ecchymosis (Battle’s Sign)
Hemotympanum
Clear rhinorrhea
Otorrhea (csf)
What two things should be avoided in patients with basilar skull fractures.
Nasal intubation and NG tube insertion because the tubes could inadvertently traverse these skull fractures and enter cranium
What results due to a rupture usually veins between brain and dura?
Subdural hematoma
What does the hematoma do in the brain in a subdural hematoma?
The hematoma compresses the brain.
If it keeps getting bigger, there is a progressive decline in consciousness, possibly death.
There are FOUR types of subdural hematoma. True or false.
False. Three
What type of subdural hematoma is the most dangerous and is generally caused by severe head injury, signs/symptoms usually appear immediately?
Acute subdural hematoma
Subacute or chronic subdural hematoma develop slower. True or False.
True
In a subdural hematoma, the dura becomes unattached to the skull. True or false.
False, still attached.
What is also called extramural hematoma, where an artery rupture between the dura and the skull?
Epidural hematoma
Where does the blood leak in epidural hematoma/
Blood leaks between the dura matter and the skull to form a mass that compresses the brain tissue
The dura is peeled off the skull in epidural hematoma. True or False.
True. I
Epidural Hematoma patients are mostly unconsciousness, drowsy, or comatose from the moment of trauma. True or False.
False, some may remain conscious, but MOST become drowsy or comatose from the moment of trauma.
An epidural hematoma that affects the artery of the brain can be __ unless prompt treatment is started.
Deadly
Infants and children may demonstrate an altered mental status in the early stages after the injury. True or false.
False, May no.
When the hematoma expands in epidural hematoma, what can it lead to in infants and children?
Loss of consciousness
Hemiparesis
Pupillary dilatation
**Deterioration can be quite rapid once a mass effect occurs
What is the treatment for epidural hematoma?
Treatment is PROMPT surgical evacuation because delays are associated with INCREASED morbidity
What is the medical therapy directed towards in epidural hematoma?
Decreasing ICP-as soon as diagnosis is suspected.
Children generally recover well after these hemorrhages in epidural hematoma, although __ is usually a reflection of underlying brain injury.
Morbidity
Acute subdural hematoma is almost always traumatic and frequently as a result of __.
Abuse. Shaken Baby Syndrome
Infants less than 1 year old are at greater risk for shaken baby syndrome and the leading cause of the shaking if __ __.
Inconsolable crying
How does Shaken Baby Syndrome (SBS) occur?
When the infant is so vigorously shaken that the accelerating and decelerating rotational forces causes the bridging veings to rupture leading to SUBDURAL HEMATOMA.
