Paediatric Trauma & Emergencies

Question 1

What are the most common causes of death in the first month of life?

Answer 1

Congenital
Perinatal conditions
Prematurity

Question 2

What are the causes of decompensated respiratory failure?

Answer 2

OBSTRUCTION: Foreign body, Asthma, Croup

RESPIRATORY DEPRESSION: Raised ICP, Convulsions, Poisoning

Question 3

What are the 2 main causes of cardiac arrest in a child?

Answer 3

Decompensated respiratory failure

Decompensated circulatory failure

Question 4

What are the causes of decompensated circulatory failure?

Answer 4

FLUID LOSS: Vomiting, burns, blood loss

FLUID MALDISTRIBUTION: Septic shock, cardiac failure, anaphylaxis

Question 5

How is the airway opened in different age groups?

Answer 5

Infants: Neutral position, horizontal plane
Children: ‘Sniffing the morning air’, extended head
Older children: Head tilt, chin lift, jaw thrust
Airway adjuncts
Abnormal sounds?

Question 6

How is breathing assessed?

Answer 6

Effort: Accessory muscle use, subcostal & intercostal recession, tracheal tug, nasal flaring, head bobbing, grunting
Efficacy: Symmetry, saturations, ABG & CO2 levels, auscultation
Effects: Effects on the rest of the body- HR, mental status, Cap refill, pallor/mottling

Question 7

What is grunting a sign of?

Answer 7

Forming own PEP breathing out against pressure

Question 8

What are pre-terminal signs

Answer 8

Sats <85% on air
Silent Chest
Cyanosis
Hypotension!

Question 9

How much oxygen is given to a child in an emergency?

Answer 9

15L/min non-rebreathe

Aim for sats of 94-98%

Question 10

When can increased effort be absent?

Answer 10

Exhaustion
Neuromuscular disease
Central respiratory depression

Question 11

How is circulation assessed?

Answer 11

HR
BP
Pulse Vol
Cap refill Peripherally & centrally
Skin Temperature & Colour
Urine output
Mental status

Question 12

What can be done if a cannula cannot be sited?

Answer 12

Intraosseous

Proximal Tibia

Question 13

How is a shocked child resuscitated?

Answer 13

0.9% Saline based on age & size

20mls/kg as bolus

Question 14

How is disability assessed?

Answer 14

AVPU/GCS (modified)
Glucose
Pupils: Dilated/constricted, fixed/responsive, equal/different sizes
Posture 
Evidence of seizure activity

Question 15

How is disability responded to?

Answer 15

Protect airway
ET tube if GCS <8
Glucose if hypoG (glucose <4)
Treat seizures w/Benzos

Question 16

How is circulatory issues responded to?

Answer 16

Fluids
3 or 12 lead ECG
ABG
IV/IO access
Bloods: FBC, U&E, LFTs, CRP, Cross match, cultures, Coagulation

Question 17

What is posturing a sign of?

Answer 17

Coning?

Question 18

What is assessed in the exposure section?

Answer 18

Rashes
Temperature
Injuries: Fractures, bruising, burns
Smells: Ketones, Poisons
Drug chart review

Question 19

What is the APGAR scoring system?

Answer 19

Score 0-2points per category
Activity: Muscle tone- absent, flexed, active movement
Pulse: Absent, <100, >100
Grimace: Reflex & irritability- Flaccid, some flexion of extremities, active motion (cough, sneeze, pull away)
Appearance: Skin colour- Blue/pale, pink w/blue extremities, completely pink
Respiration: Absent, slow, vigorous cry
Scoring: 0-3 Severely depressed, 4-6 mod depressed, 7-10 excellent condition

Question 20

How is anaphylaxis treated?

Answer 20

Oxygen
Positioning
Oral antihistamine
Adrenaline 1:1000 IM
Chlorphenamine Maleate IV
Hydrocortisone IV (delayed action)

Question 21

How is hypoglycaemia treated?

Answer 21

IV 10% Dextrose 2.5ml/kg
OR
IM Glucagon

Question 22

How is hyperkalaemia treated?

Answer 22

1 ECG and cardiac monitoring
2 IV Ca gluconate 10% 0.5-1ml/kg over 5-10 mins
3 Actrapid insulin 0.1units/kg in 2ml/kg 25% dextrose IV over 30 mins
4 Cal resonium

Question 23

What is IVH?

Answer 23

Bleeding into brains ventricular system
Unclear cause
Symptoms related to where the bleed is 
Complication: Can lead to cerebral palsy
Mx: Can be multiple LPs to drain the blood