Paediatric trauma Flashcards
Risk of hypothermia in children
Large surface area to body mass
Hypothermia develops more quickly than adults
Bone fracture in children
Rarely have fractures as bones not calcified
If present implies transfer of a large amount of force
Most common cause of cardiac arrest in children
Hypoxia
Correct positioning of children on resuscitation table for airway maintenance
Appropriate ETT depth (in cm) calculation in children
3 times the tube size
eg a 4.0 ETT, should be positioned at 12 cm from gums
What type of ETT is used in infants
Uncuffed
The narrowest part of the airway (cricoid ring) forms a natural seal around the ETT
Use of cuffed airway in paeds
Previously avoided as risk of necrosis
However, newer models are much better, cuff pressure <30mmHg is safe
Cuffed ETT for toddlers and small children provides improving ventilation and CO2 management
Sizing of ETT tube
Diameter similar to the end of the little finger
Heart rate changes in infants undergoing intubation
Needle and tube thoracostomy landmarks in children
Needle decompression over the top of 3rd rib in the midclavicular line
Chest tube 5th intercostal space, anterior to the midaxillary line
Estimation of the mean systolic pressure with age
SBP= 90+ 2*age(yrs)
Estimation of lower limit of normal for SBP in kids
70 + 2 * age (in yrs)
Estimation of diastolic pressure in kids
Around 2/3 of SBP
Normal physiological obs values for children
Ways of getting children’s weight
Ask caregiver
Use length based resuscitation tape
Last resort: use wt= 2*age + 10 in kg
The blood volume in infant, child age 1-3 and child over 3
Infant 80mls/kg
Child 1-3 yr 75ml/kg
child over 3 70ml/kg
The preferred IV access methods in kids
- IV ACF or saphenous vein
- IO anteromedial tibia or distal femur
- percutaneous femoral vein line
- percutaneous external or internal jugular or subclavian vein
Complications of IO access
Cellulitis
OM
Compartment syndrome
Iatrogenic fracture
Preferred site of IO access
Anteromedial tibia
Distal femur
Fluid resus protocol in kids
Traditionally:
Up to 3 boluses of 20ml/kg of warm isotonic solution
Followed by 10ml/kg of RBC
Evidence emerging:
One 20ml/kg bolus of isotonic solution
Followed by 1:1:1 of RBC, platelets and FFP at 10-20ml/kg
Risk of malignancy with CT scanning in children
1 in 1000 will develop fatal cancers
Developmental milestones
How HR and blood pressure change in children with various degrees of blood loss
Heart rate compensates for longer
CT head criteria in children
