Paediatric Trauma

Question 1

what is the commonest bone fracture seen in children?

Answer 1

clavicle fracture

Question 2

name a few common fractures seen in children

Answer 2

buckle fracture
toddler’s facture
greenstick fracture

Question 3

how are buckle fractures treated?

Answer 3

same treatment as a sprain - RICE (rest, ice, compression, elevation)

Question 4

what is the classification used for fractures at the epiphyseal growth plate?

Answer 4

salter harris classification

Question 5

why is a Salter Harris type 1 fracture difficult to diagnose?

Answer 5

because it is not seen on xray

Question 6

what is an important feature in the history when a child presents with a wound, and why?

Answer 6

the mechanism of injury is important. a small wound may be very deep

Question 7

what is the difference between a burn and a scald?

Answer 7

burn are caused by dry heat, can penetrate through skin

scalds are normally caused by boiling liquid, superficial

Question 8

if children present with burns, what other organ should also be assessed?

Answer 8

lungs - for inhalational injury

Question 9

what are the commonest types of injuries children present with?

Answer 9

fractures
wounds
scalds/burns
head injuries
NAI

Question 10

what is an important non-physical injury in children, and what sort of things can cause it?

Answer 10

hypoglycaemia

can be caused by cold, alcohol, drugs etc

Question 11

what anatomical features of children cause them to be injured more easily?

Answer 11

• relatively large head, easily injured
• smaller surface area, same trauma can cause more damage than in adults
• skeleton is not fully developed yet, less vital organ protection
• vital organs are crowded in abdomen

Question 12

what physiological features in children cause them to be injured more easily?

Answer 12

children are prone to hypothermia and hypoglycaemia

Question 13

in life-threatening trauma in children, what are the commonest causes of respiratory obstruction leading to respiratory failure?

Answer 13

foreign object inhalation
pneumothorax
severe asthma attack

Question 14

in life-threatening trauma in children, what are the commonest causes of respiratory depression leading to respiratory failure?

Answer 14

raised ICP
poisoning
seizures

Question 15

what is the main cause of raised ICP in children?

Answer 15

head injury

Question 16

in life-threatening trauma in children, what are the commonest causes of circulatory failure?

Answer 16

• fluid loss (massive haemorrhage, burns)

- fluid maldistribution (sepsis, anaphylaxis)

Question 17

what is the primary survery during a child’s admission into A&E?

Answer 17

cABCDE

Question 18

what is the secondary survey during a child’s admission into A&E?

Answer 18

full detailed assessment of a child once resuscitated/identified as stable

Question 19

when are the three peaks of child deaths in major trauma? name a few causes for each

Answer 19

peak 1 - die at the scene (irreparable brain damage/blood loss)
peak 2 - die during resuscitation (cABCDE failure)
peak 3 - die despite emergency treatment/resuscitation (multi-organ failure, sepsis)

Question 20

what is the golden hour in terms of emergency medicine?

Answer 20

the first hour since the injury - intervention during that time gives highest chance of survival and recovery

Question 21

what is the aim of trauma resuscitation?

Answer 21

to restore normal oxygenation as quickly as possible