Paediatric BLS and Trauma Flashcards
Outline the steps of resuscitation of a newborn
DAM I ResusCitAte (RCA)
Dry
Assess (APGAR)
Meconium in mouth (suck if presence)
Inflation breath 5 (via mask)
Reassess (APGAR)
Compression (if HR<60)
Adrenaline
Airway suction should not be performed unless there is obviously thick meconium causing obstruction - why is this?
May cause reflex bradycardia in babies
What are the basic steps of paediatric life support?
unresponsive? = shout for help
open airway, look, listen, feel for breathing
give 5 rescue breaths
check for signs of circulation
15 chest compressions:2 rescue breaths
How should you check for pulses in infants vs children?
infants = use brachial or femoral pulse
children = use femoral pulse
What technique should be used for chest compression in infants and children?
in infants: use a two-thumb encircling technique for chest compression
in children: compress the lower half of the sternum
What is the rate and depth of paediatric chest compressions?
100-120/min
1/3 of the anterior–posterior dimension of the chest
A child only responding to pain suggests what GCS score?
less than 8 = INTUBATE
What are decorticate and decerebrate positions?
decorticate - arms flexed to chest
decerebrate - arms extended and externally rotated = WORSE
What are the ‘big five’ of paeditaric ED?
hypoxia
hypotension - children compensate very well until they are about to arrest
silent chest
unequal pupils
posturing - decorticate / decerebrate
How should bite injuries be investigated and managed?
Investigations:
Photographs of the wound
Any purulent material present should be swabbed
Routine bloods (including FBC and CRP)
X ray : to ensure no residual foreign material is deep within the wound, as well as ensuring no fracture is present
Management:
Cleaning
Oral antibiotics
Debridement and washout if indicated
Tetanus immunisation if a patient has not had a booster within the last 10 years
How should suspected C spine injuries be investigated in children?
MRI (as opposed to CT in adults)
How should C spine fractures be managed?
3-point C-spine immobilisation
Rigid collar / halo vest
If unstable = operative mx
Describe the typical displacement of clavicular fractures in kids
The medial fragment will often displace superiorly, due to the pull of the sternocleidomastoid muscle, whilst the lateral fragment will displace inferiorly from the weight of the arm.
What should you look for on examination of a clavicular fracture?
Due to the subcutaneous location of the clavicle, it is important to specifically look for open injuries or threatened skin (appearing as tented, tethered, white, and non-blanching skin)
Ensure to check the neurovascular status of the upper limb - in case of brachial plexus injuries
Also check for surgical emphysema, which may indicate a pneumothorax.
How should clavicular fractures be investigated and managed?
Plain film anteroposterior and modified-axial radiographs of the affected clavicle should be performed
most clavicle fractures can be treated conservatively- sling and early mobilisation of the shoulder, heals in 4-6 weeks
Where fractures have failed to unite - open-reduction internal-fixation (ORIF)
Complications of clavicular fractures?
non-union
neurovascular injury
any puncture injury
Supracondylar humeral fractures are a common paediatric elbow injury. How do they occur?
The peak age of incidence is 5-7 years. The most common mechanism of injury is falling on an outstretched hand with the elbow in extension
How should supracondylar humeral fractures be investigated?
plain film radiographs - (AP) and lateral views of the elbow
Subtle signs on plain film radiograph for a supracondylar fracture include:
Posterior fat pad sign (lucency visible on the lateral view)
Displacement of the anterior humeral line (in children >5yrs, this should intersect the middle third of the capitellum)
How should supracondylar humeral fractures be managed?
Patients with supracondylar fractures with associated neurovascular compromise on presentation need immediate closed reduction
In children, this will be performed in theatre; the reduction is then secured with K-wire fixation (which can be removed in clinic after 3-4 weeks).
Complications of supracondylar humeral fractures?
Nerve palsies
The anterior interosseous nerve is most commonly affected by the initial injury, however ulnar nerve palsy is the most common post-operative complication (at risk during insertion of the medial K-wire)
Malunion
In some cases, patients may even develop a cubitus varus deformity (often termed “gunstock deformity”), whereby the extended forearm deviates towards the midline.
A Volkmann’s contracture can occur following vascular compromise
wrist and hand held in permanent flexion, as a claw-like deformity
