Paediatric trauma

Question 1

commonest cause of death in childhood in the uk

Answer 1

trauma

Question 2

which traumas account for 80% of injuries in children 2

Answer 2

RTAs

falls

Question 3

after a traumatic injury in a child when would you be prompted to inform a surgeon 1

Answer 3

if a child requires moer than 40ml per kilogram of fluid resus

Question 4

5 important principles of primary survey of a child whose suffered at traumatic injury (just exlain A-E)

Answer 4

1. Airway and C-spine
2. Breathing – look listen feel; Administer O2
3. Circulation; HR BP CRT; IV access, bloods
4. Disability – GCS (modified) /AVPU
5. Exposure - remember hypothermia (DEFG = Don’t Ever Forget the Glucose)

Question 5

calculation for estimating childs weight

Answer 5

(age + 4) x 2

Question 6

head injury in child
-aspects of history? 5

Answer 6

 How did it happen?
 Any vomiting?
 Any loss of consciousness or post traumatic amnesia
 Any other injury?
 Does story fit? (?NAI)

Question 7

head injury in child
-aspects of examination 5

Answer 7

 GCS/AVPU
 What is the HR and BP
 Examine their head; Is there a boggy haematoma?
 Signs of skull # (i.e. Battles sign etc) ;
 Neuro exam

Question 8

indications for Ct scan for head injury in child
-what length of a witnessed LOC would prompt this

Answer 8

over 5 minutes

Question 9

what lengths of amensia- antegrade or retrograde- would prompt a CT after a head injury in a child

Answer 9

over 5 minutes

Question 10

how many episodes of vomitting would prompt a CT in a child with a head injury

Answer 10

3 or more DISCRETE episodes

Question 11

indications for Ct scan for head injury in child -except for LOC length, amnesia length and vomitting 9

Answer 11

 Abnormal drowsiness
 Clinical suspicion of non-accidental injury
 Post-traumatic seizure (no PMH of epilepsy)
 GCS <14 in emergency room
(Paediatric GCS <15 if aged <1)
 Suspected open or depressed skull fracture or tense fontanelle
 Signs of base of skull fracture*
 Focal neurological deficit
 Aged <1 - bruise, swelling or laceration on head >5 cm
168
 Dangerous mechanism of injury (high-speed RTA, fall from >3 m, high-speed
projectile)

Question 12

management of a severe head injury in a child 5

Answer 12

consider trauma call
A-E
maintain ventilation and oxygenation
control seizures
consider analgesia

Question 13

measures to decrease intracrainal pressure in a head injury in a child 5

Answer 13

30degree head angle -after correcting any shock

maintain BP

aim to ventilate normal pCO2

consider IV 3% NaCL 3ml/kg as bolus
or
IV mannitol over 20 minutes

Question 14

management of moderate head injury in a child 2

Answer 14

consider analgesia

30 minutley neuro obs

Question 14

management of moderate head injury in a child 2

Answer 14

consider analgesia

30 minutley neuro obs

Question 15

management of base of skull fracture 3

Answer 15

check pneumococcal vaccine up to date
-invasive pneuococcal infection is a known complication of this

if involves ear canal-> ENT review

concerns-discuss w peads neurosurg

Question 16

management of close depressed skull fractures 1

Answer 16

minimally depressed skull fractures
-require no operative intervention

DW w paeds neurosurg

Question 17

management of open depressed skull fractures 3

Answer 17

if minimally depressed- no operative intervention required
-wounds should be cleaned and closed by ED team wherever possible

For significant depressed fracture / severe contamination / required theatre to close wound, discuss with paediatric neurosurgical team.

Antibiotics for severe contamination, as per microbiological advice / guidelines

Question 18

important point regarding imaging a child in trauma

Answer 18

There is no place for routine ‘whole body’ or ‘pan scan’ imaging in children, who are considerably more radiation sensitive. There is no role for routine screening pelvis radiographs. Trauma imaging in children should be targeted and selective. This guidance should always be used alongside clinical
judgment.

Question 19

imaging for child in a trauma situation:
-major shrapnel injury or explosive blast injury

Answer 19

scout CT whole body
-CT affected areas

Question 20

imaging for child in a trauma situation:
-massive/ life threatening injury 4

Answer 20

Ct abdo and pelvis

± head jury-> CT head

± strong suspicion or abnormal X-ray
-CT Thorax
-CT Cervical Spine

Question 21

imaging for child in a trauma situation:
polytrauma with abnormal physiology

Answer 21

conisder first line CXR and cervical Spine X-ray

Question 22

imaging for child in a trauma situation:
peritonism or any of the following
-ecchymosis
tenderness
distension
PR or NG blood
lap belt injury

Answer 22

CT Abdo & Pelvis

Question 23

imaging for child in a trauma situation:
penetrating trauma

Answer 23

CT affected areas

Question 24

imaging for child in a trauma situation:
NICE head injury criteria met

Answer 24

CT head

Question 25

imaging for child in a trauma situation:
concerns of spinal column injry or abnormal neurology

Answer 25

MRI spine area of concern