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CSB339 > Paediatric trauma > Flashcards

Paediatric trauma Flashcards

1
Q

Unintentional injuries make up what percentage of all child injury deaths?

A

95%

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2
Q

What age group is most at risk of unintentional injury?

A

Young children under 5

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3
Q

Child deaths from unintentional injury are most commonly the result of what four things?

A

Car crashes, child pedestrians being hit by motor vehicles, drowning, and house fires

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4
Q

Hospitalization of young children from unintentional injury and most commonly the result of what five things?

A

Falls, poisoning, scalding, choking, and dog bites.

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5
Q

What are the leading causes of hospitalization for school aged children?

A

Falls, cutting and piercing injuries, car passenger injuries, and pedestrian injuries.

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6
Q

Where is the most common place for young children to be injured?

A

In their own home.

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7
Q

Higher metabolic rate in pediatrics results in greater consumption of oxygen and other metabolites. What physiological responses accommodate this?

A

Higher heart and respiratory rates.

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8
Q

The larger surface area to body mass ratio in paeds results in…

A

Greater heat loss for infants and children.

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9
Q

Pediatrics have ____ glucose requirements but ____ glycogen stores.

A

Increased; decreased.

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10
Q

The smaller the child, the greater the likelihood a single impact will…

A

Injure multiple organ systems.

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11
Q

The smaller body mass of a child results in what secondary to the traumatic impact?

A

Greater forces applied per unit body area.

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12
Q

The ribs of an infant are positioned more ____ than those of an adult.

A

Horizontally.

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13
Q

What is the significance of infant rib position with regard to inspiration and tidal volume?

A

With inspiration the ribs only move up, rather than up-and-out like adults. This limits the capacity to increase tidal volumes.

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14
Q

What is the chief physiological response to hypoxia in paeds and why?

A

Tachypnoea, due to limited pulmonary compliance and greater chest wall compliance.

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15
Q

Why do infants and young children exhaust more quickly than adults?

A

Because of the small a number of fatigue-resistant type I fibers in their respiratory muscles.

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16
Q

Infants are what kind of breathers?

A

Diaphragmatic.

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17
Q

Is hypotension necessary to define shock?

A

No, though the misconception persists.

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18
Q

What is the definition of shock?

A

A life threatening condition characterized by inadequate delivery of oxygen and nutrients to vital organs relative to their metabolic demand.

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19
Q

Inadequate oxygen delivery typically results from ____ ____ ____ but may also be caused by ____ ____ ____.

A

Poor tissue perfusion; increased metabolic demand.

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20
Q

Shock must be recognized by what four symptoms before hypotension?

A

Tachycardia, poor skin color, altered conscious level, and prolonged capillary refill BEFORE hypotension occurs.

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21
Q

Hypotension is a ____ and ____ sign of hypovolaemia in children.

A

Late; critical.

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22
Q

What is the blood volume of paeds?

A

80-90 mL/kg

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23
Q

What is the blood volume of adults?

A

65-70 mL/kg

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24
Q

To increase cardiac output infants are limited to increasing their ____ ____ as they are unable to increase ____ ____.

A

Heart rate; cardiac output.

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25
Q

What two common experiences in paediatric trauma cause elevation of the diaphragm and severely compromise vital capacity?

A

Aerophagia and gastric distension.

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26
Q

Elevation of the diaphragm and compromised vital capacity can predispose infants and young children to the sudden development of what when fatigued?

A

Apnea

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27
Q

At least ____% of children dying with multiple trauma have significant head injuries, compared with ____% of adults.

A

80%; 50%

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28
Q

Head stability in paeds is dependent on the ____ rather than bony structure.

A

Ligamentous

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29
Q

The unmyelinated brain is more susceptible to what kind of injuries?

A

Shear injuries

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30
Q

Why are paed brains more prone to acceleration/deceleration injury?

A

High water content (88% compared to 77% in adults), making the brain softer

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31
Q

Children tend to have a higher incidence of what kind of brain injury?

A

Diffuse axonal injury

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32
Q

Children with severe head injury are more likely than adults to have ____ ____.

A

Intracranial hypertension

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33
Q

Intracranial hypertension can contribute to what two things?

A

Ischaemia and herniation

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34
Q

Children are more prone to a unique form of brain injury called ____ ____ ____.

A

Malignant brain oedema

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35
Q

Malignant brain oedema is said to be due to what three things?

A

Osmolar shifts and oedema at the cellular level
Blood-brain barrier breakdown
Secondary injury/insults

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36
Q

Predisposition to cerebral hyperaemia and resulting intracranial hypertension makes children more vulnerable to…

A

Secondary brain injury.

37
Q

True or false: infants form the only age group that can go into shock solely due to head injury.

A

True

38
Q

The cervical spine fulcrum changes from ____ to ____ in toddlers two ____ to ____ by ages 8 to 12 years.

A

C2-C3; C5-C6

39
Q

True or false: children can have spinal nerve injury without damage to the vertebrae.

A

True

40
Q

What does SCIWORA stand for?

A

Spinal chord injury without radiographic abnormality.

41
Q

Why are rib fractures a serious sign in paediatric trauma?

A

Increased elasticity and chest wall compliance mean blunt chest trauma may not result in a rib fracture, but the force can be transmitted through the ribs to underlying structures. A force significant enough to fracture ribs is a marker of increased morbidity and mortality.

42
Q

Increased mobility of the mediastinum increases the likelihood that an injured child with blunt chest trauma may develop what two complications?

A

Develop a tension pneumothorax from a simple pneumothorax, and transect a small mediastinum vessel as the mediastinum shifts.

43
Q

What are the six lethal forms of chest trauma?

A

Airway obstruction, open pneumothorax, tension pneumothorax, massive haemothorax, flail chest, and cardiac tamponade.

44
Q

What are the six hidden forms of chest trama?

A

Cardiac contusions, aortic disruption, tracheobronchial disruption, oesophageal disruption, diaphragmatic tear, and pulmonary contusion.

45
Q

Why is traumatic asphyxia observed in children?

A

Flexible thorax and absence of valves in the venous system of the inferior and superior vena cava.

46
Q

What might occur if the glottis is closed and the thoracoabdominal muscles are transferred at the time of chest injury?

A

Increased intrathoracic pressure is transmitted through the central venous system to organs like the brain, liver, spleen, and kidneys.

47
Q

Where does the paed abdominal region begin?

A

At the level of the nipple.

48
Q

Why is abdominal trauma more likely to result in liver or spleen damage in the child compared to the adult?

A

These organs take up a greater proportion of the abdominal cavity in children, and the diaphragm of the child is flatter and less dome-shaped than that of an adult and consequently tends to push the liver and spleen lower below the rib cage.

49
Q

The bladder in infants is what kind of organ?

A

Intra-abdominal

50
Q

Kidneys are less protected and more mobile, making them more susceptible to what kind of injury?

A

Deceleration

51
Q

Approximately ___% of extremity fractures in children involve disruptions of the growth plate.

A

15%

52
Q

When do epiphyseal plates fuse?

A

When children reach skeletal maturity, which occurs after puberty.

53
Q

Describe a type I fracture.

A

A complete physeal fracture with or without displacement.

54
Q

Describe a type II fracture.

A

A physeal fracture that extends through the metaphysis, producing a chip fracture of the metaphysis which may be very small.

55
Q

Describe a type III fracture.

A

A physeal fracture that extends through the epiphysis.

56
Q

Describe a type IV fracture.

A

A physeal fracture plus epiphyseal and metaphyseal fractures.

57
Q

Describe a type V fracture.

A

A compression fracture of the growth plate.

58
Q

What is the general rule of open fractures and blood loss?

A

Open fractures double the blood loss.

59
Q

A single open femoral fracture may result in ____% loss of circulating blood volume.

A

40%

60
Q

List the 5 significant differences between paediatric and adult burn victims.

A
  1. Children have increased airway vulnerability
  2. Children are more susceptible to carbon monoxide intoxication
  3. Children have an increased risk of hypothermia
  4. Children have different body-to-surface proportions than adults which affects the estimation of the extent of the burn
  5. A child’s skin is much thinner than an adult’s which makes children more prone to deeper, more severe thermal injuries
61
Q

What is eschar and how is it formed?

A

Full thickness circumferential and near-circumferential skin burns result in the formation of a tough, inelastic mass of burnt tissue called eschar.

62
Q

As a result of its inelasticity, eschar results in…

A

Burn-induced compartment syndrome.

63
Q

____% of all children with severe head injury will have an accompanying cervical spine injury.

A

20%

64
Q

True or false: isolated head injury or isolated femur fracture generally do not cause hypotension in paeds.

A

True

65
Q

What are the points of Waddell’s Triad?

A

Typical pattern of injuries affecting the 1) upper leg, 2) chest/abdomen, and 3) head

66
Q

What are the two greatest initial threats to paediatric patient survival?

A

Respiratory failure and shock.

67
Q

List some signs of significant blood loss.

A

Heart rate - marked or increasing tachycardia or relative bradycardia
Systolic BP - falling
Capillary refill time - increased to 4-5 seconds
Respiratory rate - tachypnoea unrelated to thoracic problem
Mental state - ALOC unrelated to head injury

68
Q

What are the age ranges for the three modified GCS?

A

Infant <1
Child 1-4
Adult 4+

69
Q

What should be avoided and corrected immediately upon identification when managing TBI?

A

Hypoxaemia

70
Q

What kind of solution should be used to treat hypotension for paediatric TBI patients?

A

Isotonic

71
Q

What systolic BP should be aimed for when treating hypotension in the paediatric TBI patient?

A

Higher than the fifth percentile for their age.

72
Q

What is the formula for approximating the 5th percentile of a paediatric pt’s systolic BP?

A

(Age x 2) + 70

73
Q

Paediatrics with TBI should be assessed frequently for clinical signs of ____ ____.

A

Cerebral herniation.

74
Q

What are the clinical signs of cerebral herniation?

A
  • Dilated and unreactive pupils
  • Asymmetric pupils
  • A motor exam that identifies either extensor posturing or no response
  • Progressive neurologic deterioration (a decrease in the GCS of more than 2 points from the patient’s prior best score in patients with initial GCS <9)
75
Q

Patients should be maintained with normal breathing rates (ETCO2 35-40mmHg) and hyperventilation (ETCO2 <35mmHg) should be avoided unless what?

A

The patient show signs of cerebral herniation.

76
Q

Should hyperventilation be continued when clinical signs herniation resolve?

A

No, it should be discontinued.

77
Q

How many breaths per minute in infants <1 constitutes hyperventilation?

A

30 breaths per minute.

78
Q

How many breaths per minute in a child constitutes hyperventilation?

A

25 breaths per minute.

79
Q

What is the ETCO2 range goal of hyperventilation?

A

30 - 35 mmHg

80
Q

What might give cause for recognition of need for pain relief or control?

A
  • A description from the child or parent/carer
  • Behavioral changes such as crying, guarding injured part, and facial grimacing
  • Physiological changes such as pallor, tachycardia, and tachypnoea which are observed by the paramedic
  • An expectation of pain because the pathophysiology involved such as fracture, burn, or other significant trauma or condition
81
Q

Failure to provide adequate pain management to infants and children can cause fluctuations in what five things?

A
  • HR
  • BP
  • ICP
  • SPO2
  • Stress hormone levels
82
Q

True or false: inadequate early pain management may contribute chronic pain syndromes.

A

True

83
Q

True or false: you do not need to assess the precise degree of pain in order to treat it.

A

True.

84
Q

For neonates and infants, pain assessment tools often rely on:

A

Behavioral observations by caregivers and paramedics, and physiological changes in the patient.

85
Q

What is the FLACC scale?

A

A behaviour scale that can be used for children under 3 years of age or who are unable to communicate.

86
Q

An infant who is not consoled when rocked or held by parents or who cannot sustain sucking activity without crying is generally experiencing ____ ____.

A

Significant pain.

87
Q

What are some additional pain responses in young infants?

A
  • Signs of agitation
  • Increased reactivity to stimulation
  • Tremulous or clonic movements
88
Q

What materials are needed for intranasal fentanyl?

A
  • 1mL or 3mL syringe
  • Drawing up needle
  • Atomiser
  • Vial of fentanyl
89
Q

What additional pain interventions are offered by a CCP?

A
  • Increased morphine dose
  • Ketamine
  • Consult for midazolam

CSB339 (7 decks)

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