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ATLS > Paediatric trauma > Flashcards

Paediatric trauma Flashcards

1
Q

Leading causes of unsuccessful resuscitation in paediatric patients with severe trauma

A

Failure to secure compromised airway
Failure to support breathing
Failure to recognise / respond to intra-abdominal and intracranial haemorrhage

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2
Q

WET FLAG acronym

A

Weight
Energy
Tube

Fluid bolus
Lorazepam
Adrenaline
Glucose

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3
Q

Weight from WET FLAG

A

ATLS formula = (Age + 5) x 2 kg
WET FLAG formula = (Age + 4) x 2 kg

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4
Q

Energy from WET FLAG

A

Weight x 4 Joules

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5
Q

Tube from WET FLAG

A

Internal diameter = (Age / 4) + 4 cm
Length (oral) = (Age / 2) + 12 cm
Length (nasal) = (Age / 2) + 15 cm

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6
Q

Fluids from WET FLAG

A

Bolus of fluid:

Medical = 20 ml/kg
Trauma = 10 ml/kg

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7
Q

Lorazepam from WET FLAG

A

0.1 mg/kg

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8
Q

Adrenaline from WET FLAG

A

0.1 ml/kg of 1:10,000

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9
Q

Glucose from WET FLAG

A

2 ml/kg of 10% Dextrose

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10
Q

Clinical decision tools in paediatric trauma patients

A

Field triage decision scheme

Paediatric trauma score

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11
Q

Role of clinical decision tools in paediatric trauma patients

A

For early identification of multi-system injuries and to guide transfer to higher level centres within trauma system

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12
Q

Estimated normal systolic BP calculation in paediatric patients

A

(Age x 2) + 90

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13
Q

Estimated lower range of normal systolic BP calculation in paediatric patients

A

(Age x 2) + 70

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14
Q

Estimated normal diastolic BP calculation in paediatric patients

A

2/3 systolic BP

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15
Q

HR in age 0-1 yrs

A

<160

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16
Q

BP in age 0-1 yrs

A

> 60

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17
Q

RR in age 0-1 yrs

A

<60

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18
Q

UO in age 0-1 yrs

A

2 ml/kg/hr

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19
Q

HR in age 1-2 yrs

A

< 150

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20
Q

BP in age 1-2 yrs

A

> 70

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21
Q

RR in age 1-2 yrs

A

< 40

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22
Q

UO in age 1-2 yrs

A

1.5 ml/kg/hr

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23
Q

HR in age 3-5 yrs

A

< 140

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24
Q

BP in age 3-5 yrs

A

> 75

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25
Q

RR in age 3-5 yrs

A

< 35

26
Q

UO in age 3-5 yrs

A

1 ml/kg/hr

27
Q

HR in age 6-12 yrs

A

< 120

28
Q

BP in age 6-12 yrs

A

> 80

29
Q

RR in age 6-12 yrs

A

< 30

30
Q

UO in age 6-12 yrs

A

1 ml/kg/hr

31
Q

HR in age 13 yrs and older

A

< 100

32
Q

BP in age 13 yrs and older

A

> 90

33
Q

RR in age 13 yrs and older

A

< 30

34
Q

UO in age 13 yrs and older

A

0.5 ml/kg/hr

35
Q

Priorities for assessing and managing paediatric trauma

A

Same as adults
ABCDE

36
Q

Unique characteristics of paediatric trauma

A

Airway and breathing issues more common that circulatory compromise

Increased heat loss

37
Q

Cause for increased heat loss in paediatric patients

A

Higher surface area to volume ratio

Higher metabolic rate than adults

Less subcutaneous tissue than adults

38
Q

Methods for estimating weight and drug doses for children

A

WET FLAG and WAtCH drugs

Length based paediatric resuscitation tapes

Ask parent

39
Q

Anatomical differences in paediatric patient for airway assessment

A

Large occiput causes passive flexion of c spine
Trachea is shorter for intubation

40
Q

Changes to airway management of paediatric patient

A

Maintain plane of midface parallel to spine board in neutral position

Achieved by placing cushion under entire torso of child, but not under head

41
Q

Age by which cricothyroid membrane is usually palpable

A

By age 12 years and older

42
Q

Common causes of deterioration / drop in sats of an intubated patient

A

DOPE

43
Q

D of DOPE

A

Dislodgement of ET tube

44
Q

O of DOPE

A

Obstruction

Secretions of kinking
Can try suctioning tube

45
Q

P of DOPE

A

Pneumothorax

Tension pneumothorax secondary to positive pressure in patients

46
Q

E of DOPE

A

Equipment failure

Failure of ventilators, pulse oximeter or oxygen delivery device

47
Q

Most common acid-base abnormality in paediatric resuscitation

A

Respiratory acidosis due to hypoventilation

Can be exacerbated by sodium bicarbonate in absence of adequate ventilation

48
Q

Site of needle decompression of pneumothorax in children

A

Second intercostal space, midclavicular line

NOT CHANGED IN CHILDREN unlike adults

49
Q

Signs of hypovolaemia in children

A

Tachycardia
Poor skin perfusion / mottling
Narrow pulse pressure < 20 mmHg

Child’s increased physiologic reserve can maintain BP even in shock

50
Q

Sudden change from tachycardia to bradycardia in infants

A

Severe distress and >40% blood loss

Treat with rapid IV crystalloid + blood

51
Q

Options for IV access in order of preference

A

1) Peripheral percutaneous max 2 attempts
2) IO
3) Femoral line
4) Internal jugular line
5) Venous cutdown saphenous vein at ankle - last resort

52
Q

“Damage control resuscitation” definition

A

Restrictive use of crystalloid fluids and early administration of balanced ratios packed RBCs, platelets and FFP

53
Q

Management of children with transient or no response to initial resuscitation

A

Further blood products
Major haemorrhage protocol
Consideration of early operative management

54
Q

Situations where children receiving CPR are most likely non survivors

A

CPR > 15 mins
Pupils fixed

55
Q

Percentage likelihood of neurologically intact survival following ROSC after traumatic arrest and CPR in field

A

50%

56
Q

Consideration in paediatric trauma with no fractures

A

May still have underlying organ injury as bones immature

57
Q

Nasogastric tube or Orogastric tube preferred in paediatric patients

A

Orogastric tube

58
Q

Change to CT guidance in paediatric trauma

A

Only scan area of interest

59
Q

Paediatric GCS score - Verbal component

A

5 - appropriate words or social smile, fixes and follows
4 - cries but consolable
3 - persistently irritable
2 - Restless, agitated
1 - none

60
Q

ABCDEs of injury prevention in non accidental injuries

A

Analyse injury data
Build local coalitions
Communicate the problem
Develop prevention activities
Evaluate the interventions

ATLS (14 decks)

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