Paediatric trauma Flashcards
Leading causes of unsuccessful resuscitation in paediatric patients with severe trauma
Failure to secure compromised airway
Failure to support breathing
Failure to recognise / respond to intra-abdominal and intracranial haemorrhage
WET FLAG acronym
Weight
Energy
Tube
Fluid bolus
Lorazepam
Adrenaline
Glucose
Weight from WET FLAG
ATLS formula = (Age + 5) x 2 kg
WET FLAG formula = (Age + 4) x 2 kg
Energy from WET FLAG
Weight x 4 Joules
Tube from WET FLAG
Internal diameter = (Age / 4) + 4 cm
Length (oral) = (Age / 2) + 12 cm
Length (nasal) = (Age / 2) + 15 cm
Fluids from WET FLAG
Bolus of fluid:
Medical = 20 ml/kg
Trauma = 10 ml/kg
Lorazepam from WET FLAG
0.1 mg/kg
Adrenaline from WET FLAG
0.1 ml/kg of 1:10,000
Glucose from WET FLAG
2 ml/kg of 10% Dextrose
Clinical decision tools in paediatric trauma patients
Field triage decision scheme
Paediatric trauma score
Role of clinical decision tools in paediatric trauma patients
For early identification of multi-system injuries and to guide transfer to higher level centres within trauma system
Estimated normal systolic BP calculation in paediatric patients
(Age x 2) + 90
Estimated lower range of normal systolic BP calculation in paediatric patients
(Age x 2) + 70
Estimated normal diastolic BP calculation in paediatric patients
2/3 systolic BP
HR in age 0-1 yrs
<160
BP in age 0-1 yrs
> 60
RR in age 0-1 yrs
<60
UO in age 0-1 yrs
2 ml/kg/hr
HR in age 1-2 yrs
< 150
BP in age 1-2 yrs
> 70
RR in age 1-2 yrs
< 40
UO in age 1-2 yrs
1.5 ml/kg/hr
HR in age 3-5 yrs
< 140
BP in age 3-5 yrs
> 75
RR in age 3-5 yrs
< 35
UO in age 3-5 yrs
1 ml/kg/hr
HR in age 6-12 yrs
< 120
BP in age 6-12 yrs
> 80
RR in age 6-12 yrs
< 30
UO in age 6-12 yrs
1 ml/kg/hr
HR in age 13 yrs and older
< 100
BP in age 13 yrs and older
> 90
RR in age 13 yrs and older
< 30
UO in age 13 yrs and older
0.5 ml/kg/hr
Priorities for assessing and managing paediatric trauma
Same as adults
ABCDE
Unique characteristics of paediatric trauma
Airway and breathing issues more common that circulatory compromise
Increased heat loss
Cause for increased heat loss in paediatric patients
Higher surface area to volume ratio
Higher metabolic rate than adults
Less subcutaneous tissue than adults
Methods for estimating weight and drug doses for children
WET FLAG and WAtCH drugs
Length based paediatric resuscitation tapes
Ask parent
Anatomical differences in paediatric patient for airway assessment
Large occiput causes passive flexion of c spine
Trachea is shorter for intubation
Changes to airway management of paediatric patient
Maintain plane of midface parallel to spine board in neutral position
Achieved by placing cushion under entire torso of child, but not under head
Age by which cricothyroid membrane is usually palpable
By age 12 years and older
Common causes of deterioration / drop in sats of an intubated patient
DOPE
D of DOPE
Dislodgement of ET tube
O of DOPE
Obstruction
Secretions of kinking
Can try suctioning tube
P of DOPE
Pneumothorax
Tension pneumothorax secondary to positive pressure in patients
E of DOPE
Equipment failure
Failure of ventilators, pulse oximeter or oxygen delivery device
Most common acid-base abnormality in paediatric resuscitation
Respiratory acidosis due to hypoventilation
Can be exacerbated by sodium bicarbonate in absence of adequate ventilation
Site of needle decompression of pneumothorax in children
Second intercostal space, midclavicular line
NOT CHANGED IN CHILDREN unlike adults
Signs of hypovolaemia in children
Tachycardia
Poor skin perfusion / mottling
Narrow pulse pressure < 20 mmHg
Child’s increased physiologic reserve can maintain BP even in shock
Sudden change from tachycardia to bradycardia in infants
Severe distress and >40% blood loss
Treat with rapid IV crystalloid + blood
Options for IV access in order of preference
1) Peripheral percutaneous max 2 attempts
2) IO
3) Femoral line
4) Internal jugular line
5) Venous cutdown saphenous vein at ankle - last resort
“Damage control resuscitation” definition
Restrictive use of crystalloid fluids and early administration of balanced ratios packed RBCs, platelets and FFP
Management of children with transient or no response to initial resuscitation
Further blood products
Major haemorrhage protocol
Consideration of early operative management
Situations where children receiving CPR are most likely non survivors
CPR > 15 mins
Pupils fixed
Percentage likelihood of neurologically intact survival following ROSC after traumatic arrest and CPR in field
50%
Consideration in paediatric trauma with no fractures
May still have underlying organ injury as bones immature
Nasogastric tube or Orogastric tube preferred in paediatric patients
Orogastric tube
Change to CT guidance in paediatric trauma
Only scan area of interest
Paediatric GCS score - Verbal component
5 - appropriate words or social smile, fixes and follows
4 - cries but consolable
3 - persistently irritable
2 - Restless, agitated
1 - none
ABCDEs of injury prevention in non accidental injuries
Analyse injury data
Build local coalitions
Communicate the problem
Develop prevention activities
Evaluate the interventions
