Paediatric trauma

Question 1

Why should you place small children on padding to raise their body on a spine board?

Answer 1

They have larger occiputs than adults so lying flat they will passively flex the cervical spine

• you need to maintain the plane of the midface parallel to the spine board in a neutral position

Question 2

A child’s larynx is funnel shaped and therefore

Answer 2

secretions can accumulate in the retropharyngeal area

Question 3

Indications for orotracheal intubation in a child

Answer 3

-severe brain injury, requiring controlled ventilation
-when an airway cannot be maintained
-signs of ventilatory failure
-if suffered significant hypovolemia and have depressed sensorium or require operation

Question 4

DOPE mnemonic for deterioration in intubated patients (esp children)

Answer 4

D- dislodgement
O- obstruction
P- pneumothorax
E- equipment failure

Question 5

Treatment of haemothorax, pneumothorax, haemopneumothorax in children

Answer 5

Pleural decompression with chest tube

Question 6

Subtle signs of blood loss in children

Answer 6

Progressive weakening of peripheral pulses
Narrowing of pulse pressure to less than 20 mm Hg
Skin mottling
Cool extremities
Decrease in level of consciousness with a dulled response to pain

Question 7

IO placement in children

Answer 7

Anteromedial tibia

Distal femur

Question 8

Fluid resuscitation quantitiy in children

Answer 8

20ml/kg initial bolus of crystalloid

• unless access to blood products, then early administration of RBC, FFP and platelets

Blood rate: 10ml/kg

Question 9

Urine output goal for infants

Answer 9

1-2 ml/kg/hour

Question 10

Urine output goal for children aged 1-adolescent

Answer 10

1-1.5ml/kg/hour

Question 11

Urine output goal for teenagers

Answer 11

0.5ml/kg/hour

Question 12

Common abdominal injuries in children compared to adult

Answer 12

Penetrating injuries to perineum eg straddle injuries
Rupture of hollow viscus
Blunt pancreatic injury
Small bowel and mesenteric avulsion
Small bowel perforation
Blunt pancreatic injury

Question 13

Hypotension can occur in infants following significant blood loss into spaces in the brain

Answer 13

True

Question 14

Bulging fontanelles or suture diastases in infants may be a sign of

Answer 14

expanding intracranial mass lesion or brain swelling

• they may be conscious, they have more tolerance for these

Question 15

Supracondylar fractures at the elbow or knee often involve

Answer 15

vascular injury

and injury to the growth plate