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Paediatrics > Paeds Trauma > Flashcards

Paeds Trauma Flashcards

1
Q

What is the highest risk group for burns?

A

1-3yrs approx 50%
Second peak in adolescents 11-15
Much higher in boys vs girls

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2
Q

What is the most common cause of burns?

A

Scalding in all age groups (approx 75%) except for adolescents which is flame burns

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3
Q

What is the Parkland formula for fluid replacement in paeds?

A

The daily volume of fluid required
Burns % x Weight (Kg) x 4mls
Ie child with 10% burns who is 10kgs needs 400mls
1/2 given in the 1st 8hrs, other 1/2 given in the next 16hrs

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4
Q

What conditions predispose to cervical spine injury (CSI)?

A

Trisomy 21
Previous C-spine injury/surgery
Achondroplasia
Osteogenesis imperfecta
Hypermobility syndromes (Ehlers Danlos syndrome, Marfans etc)

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5
Q

What are the high risk mechanisms for C-spine injury?

A

Axial load to the head
Ejection from a vehicle
Improper restraint in an MVA
MVA >60km/hr
Rollover/head on collision
MVA with other passenger death
Pedestrian vs vehicle
Fall >3m or twice height
Kicked by or fall from a horse
Substantial torso injury

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6
Q

What are the signs of increased ICP in infants?

A

Full fontanel
Split sutures
Altered conscious state
Paradoxical irritability
Persistent emesis
Setting sun sign (upward gaze paresis, always appear to be looking down)

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7
Q

What are the 2 main types of extracranial head haematomas in children?

A

Caput succedaneum
- Freely mobile, crosses suture line

Cephalohaematoma
- Blood under periosteum and doesn’t cross suture lines

In infants scalp bleeds can be profuse and lead to shock due to large heads relative to small circulating volume

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8
Q

What are injuries typically associated with NAI?

A

Extensor surface scalding sparing the flexor surface
Metaphysial humerus corner fractures

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9
Q

What are suspicious points on history for NAI?

A
  • No history, unwitnessed or inconsistent history regarding injury
  • Mechanism incompatible with childs age or developmental ability
  • Unreasonable delay in seeking medical care
  • Stating another child caused the injury
  • Child displaying harmful, regressed or sexual behaviours
  • History of family violence or child abuse
  • Recurrent presentations with odd injuries/stories
  • Child appears afraid or not wanting to interact with caregiver
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10
Q

What is the TEN 4 FACES mnemonic for child abuse injury pattern?

A

TEN (bruising in child <4)
T- Thoracic
E- Ears
N- Neck

4
- any bruising in a child <4-6 months

FACES (injury pattern in any child)
F- Frenulum in mouth
A- angle of jaw
C- Cheek
E- Eyelids
S- Scleral injury

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11
Q

What are the risk factors for NAI?

A

Child
- Any disability
- Mental health problems
- Failure to thrive
- prematurity/low birth weight
- Unwanted child
- Frequent crying

Environment
- Domestic violence
- Unrelated adult male in the home
- Isolation
- Low SES
- Animal cruelty
- Abuse of other siblings

Care Giver
- Unplanned pregnancy
- Young or single parent
- Psychiatric illness
- Substance abuse
- Low SES/poor education
- Care giver abused as a child

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12
Q

What is a Toddlers fracture?

A

A minimal or undisplaced spiral fracture, most often affecting the tibia
*Spiral fractures of the femur are suspicious for NAI

Usually in ages 9 months - 3 yrs

Thought to be caused be new stressors placed on growing bone
Usually present with irritabilty and poor weight bearing but may not localise pain to the tibia

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13
Q

What is the typical dosing of blood products in massive haemorrhoage in paediatrics?

A

10-20ml/kg PRBC
10-20ml/kg FFP
5-10ml/kg pooled platelets
5-10ml/kg Cryo

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14
Q

What are the typical initial interventions for a paediatric major trauma?

A

Airway support and supplemental 02
C-spine precautions
Pelvic binder/long bone splints
2x large bore IV access
Ideally blood use, consider massive transfusion protocol
Replace calcium if transfusing
IV TXA 15ml/kg over 10mins, then 2mg/kg/hr for 8hrs
Warmed fluids/blankets/air to prevent hypothermia

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15
Q

What are the biochemical and physiological targets in during massive transfusion?

A

Temp >35
ph > 7.2
Calc >1.1mmol/L
Hb >70g/L
INR <1.5
lactate <4
Base excess >6
Fibrinogen >1.5g/L
Platelelets >50
APTT <1.5x normal

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16
Q

What is the PECARN rule for intraabominal injury (IAI)?

A
  • Evidence of abdominal wall trauma or seat belt sign?
  • GCS <14 and blunt abdo wall trauma?
  • Abdominal tenderness?
  • Any of thoracic trauma, subjective abdo pain, vomiting and decreased breath sounds?

If no to all then very low risk

17
Q

What is the PECARN rule for head injury in age <2?

A
  • GCS <14, AMS or palpable skull #
  • Severe mechanism
  • non-frontal scalp haematoma
    LOC >5secs or not acting normally?

If no to all the above then very low risk

18
Q

What is the PECARN rule for head injury >2yo?

A
  • GCS <14, AMS or signs of basilar skull fracture?
  • Severe mechanism?
  • Any LOC?
  • Vomiting or severe headache?

If no to all then very low risk

19
Q

Whys is the NEXUS score used for paediatric C-spine?

A

Validated for children with 100% sensitivity and 100% NPV

NSAID mnemonic
N- Neurology?
S- Spinal tednerness?
A- Altered mental state?
I- Intoxication?
D- Distracting injury?

20
Q

How is the C-spine scored in children <5yrs?

A

NEXUS but intoxication is replaced with torticollis

NSATD
Neurology?
Spinal tenderness?
AMS?
Tortiollis?
Distracting injury?

21
Q

What are some of the differences between adults and children with trauma?

A

Prone to hypoxia
- Increased 02 consumption, diaphragmatic breathing, low FRC
Pliable ribs
- less rib fractures but more damage to thoracic structures
Response to blood loss
- Hypotension is pre-arrest sign of haemorrhagic shock
Narro airway
- Prone to obstruction
Anterior larynx
- Difficult intubation
Smaller patient
- Multiple systems injured
Increase surface area:mass
- Prone to hypothermia
Development
- Paediatric GCS/AVPU

22
Q

What are the doses of blood products in paediatrics?

A

PRBC
- 10ml/kg

Cryoprecipitate
- 5-10ml/kg

FFP
- 10-20ml/kg

Platelets
- 10ml/kg

If you say 10ml/kg for all then technically you are correct

23
Q

In order of frequency what are the most common features of paediatric concussion syndrome?

A

Headache- 93%
Dizziness- 75%
Difficulty concentrating- 57%
Confusion- 46%
Vision change- 38%
Nausea- 29%
Drowsiness- 27%

24
Q

How is paediatric concussion diagnosed?

A

A history of trauma mechanism
- Either direct blow to head or blow to body with rapid head rotation

Typical concussive symptoms
- Onset soon after injury
- Represents a change from baseline

Standardised assessment
- Neurological symptoms and signs, balance testing, neuropsychology

Exclusion of intracranial injuries
- Clinic findings and course
- Or neuroimaging

25
Q

How should a family and child be counselled when diagnosed with concussion syndrome?

A

Avoid further injury
Graduated return to sport
Graduated return to school
- Return to learn
- Once patients can concentrate on a task and tolerate auditory/visual stimulation for >30-45 mins (the typical length of a school period)
Symptomatic management

A brief period of physical rest, approx 24-48hrs

26
Q

What is the general management of a paediatric traumatic cardiac arrest (TCA)?

A
  • Commence CPR whilst assessing for reversible causes of arrest
  • Control obvious bleeding ie tourniquet, long bone splinting, pelvic binder direct pressure
  • Bilateral pleural decompression (finger thoracostomy controversial, use thoracostomies in 1st instance)
  • IV blood products 20ml/kg at 1:1:1 ratio
  • Secure airway with ETT, 1.0 Fi02
  • 15mg/kg IV TXA
  • Ideally, maintain spinal precuations
  • Consider alternative cause such as APLS cause, continue APLS for at least 10mins post TCA interventions
  • If all conditions met then proceed to ED resuscitative thoracotomy
27
Q

In a paediatric traumatic cardiac arrest, what factors influence the decision to cease resuscitative interventions?

A
  • Lack of response to life saving trauma interventions
  • Prolonged duration (ie >10mins) of traumatic cardiac arrest
  • Persistently low CO2
  • Cardiac standstill on POCUS
  • No reversible medical causes found
  • No specific indications for prolonged CPR ie drowning, hypothermia
  • No social indications for prolonged CPR ie family in attendance
28
Q

How are straddle injuries classified and how do they normally present?

A

Classification
- Penetrating vs blunt
- Penetrating normally need surgery and more suspicious for NAI

Females
- Normally anterior involving the clitoral hood, labia minor and mons
- Vulvar haematomas and superficial lacerations are common
- May have difficulty urinating due to haematoma pushin on urethral meatus

Abuse concerns females
- Injuries to the hymen or posterior fourchette
- True vaginal bleeding (not just from external laceration
- Perineal lacerations
- haematuria or blood at meatus without obvious external cause (suggests pelvic fracture)

Males
- Mild scrotal swelling and bruising

Abuse concerns males
- Patterned injuries
- haematuria/blood meatus
- Absent cremasteric reflex
- large lacerations or bruising
- Isolated anal injuries

29
Q

What is the difference in indication for massive transfusion protocol for kids aged < and >5?

A

<5 years old
- >20ml/kg or >2 units in 1-2 hrs with further losses anticipated

> 5years old
- >40ml/kg or >4units in 1-2hrs with further losses anticipated

Massive haemorrhage Definition
- Same all age groups
- >50% TBV in 3-4hrs
- >100% TBV in 24hrs

Paediatrics (21 decks)

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