MOD E Tech Paediatric Trauma Flashcards

1
Q

Paediatric Trauma

Causes of death in childhood

A
  • SIDS (“Cot death”) – most common between 1 month and 1 year of age
  • Between the ages of 1 and 4 the cause is equally split between congenital abnormality and trauma
  • In the UK Trauma is the most frequent cause of death after 1 year of age
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2
Q

Differences in response to injury between Adults and Children

Anatomical Considerations

Physiological Considerations

A

Anatomical Considerations

  1. The large occiput
  2. Compliant chest wall
  3. Position of the abdominal organs

Physiological Considerations

  • Smaller lung capacity
  • Smaller blood volume
  • Healthy hearts & extreme vasoconstriction
  • Larger surface area
  • Smaller glycogen stores
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3
Q

Kinematics

A
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4
Q

Assessment

  • SCENE (“First 5”)
  • <c>ABCDE</c>
A
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5
Q

Airway

A
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6
Q

Breathing

A
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7
Q

Circulation

A
  • Arrest any significant external bleeding
  • Assess skin colour and temperature
  • Capillary refill (sternum or forehead)
  • Assess pulse rate and volume
  • Signs of shock unlikely until at least 25% blood volume is lost
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8
Q

Disability / Level of Consciousness

A

•Note initial LOC on the “AVPU” scale

•If the patient does not score “A” then consider them time critical

  • Assess pupils
  • Note any spontaneous limb movements
  • Ask the patient to “wiggle” their fingers and toes
  • Measure blood glucose level in any child with altered LOC
  • Confusion or agitation in the child may arise directly from head injury or secondary to hypoxia from airway impairment, impaired breathing or hypovolaemia.
  • After initial AVPU assessment, use revised GCS

•Note any changes no matter how slight

•Children loose heat rapidly – Keep warm!

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9
Q

Head Injuries

A

•Children often fall head first

•Must prevent secondary injury due to hypoxia by adequate management of:

A + B = 100% Oxygen

  • Vomiting is common with paediatric head injuries so prevent aspiration and monitor GSC regularly
  • The skull sutures fuse at approx. 12 – 18 months.
  • Large intracranial bleeds can be accommodated without obvious abnormal neurological signs
  • Deteriorating conscious level or development of unequal pupils mandates urgent removal to hospital
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10
Q

Chest Injuries

A
  • Fractured ribs and flail segments are rare in children
  • Pneumothoraces and pulmonary contusions are more common – Tracheal deviation difficult to see due to chubby necks
  • Be aware of the signs and symptoms of respiratory distress
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11
Q

Spinal Injuries

A

•Rare, but can be catastrophic if present

•Treat the same as for an adult

•Pad under the shoulders to aid neutral positioning

•Consider manual immobilisation

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12
Q

Abdominal Injuries

A
  • Blunt trauma is the second leading cause of death in children
  • Skeleton protects abdominal organs less well in a child
  • Thin abdominal wall transmits forces easily

–internal injuries without external signs

  • GENTLE palpation
  • Think SHOCK
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13
Q

Extremity Injuries

A
  • Bones are less likely to fracture
  • Bones are able to absorb more force so underlying damage may be more severe
  • Rapid healing of fractures
  • Injuries to the growth plate can result in permanent deformity
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14
Q

Thermal Injuries

A
  • Burns and scalds are relatively common in children
  • Consider NAI if the mechanism of injury and/or history do not match the sustained injury
  • The Rule of Nines does not work in children <14years – use palmar surface
  • Burns >10% TBSA = Time Critical
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