Peadiatric Trauma Flashcards
Where are common bleeding sites for paediatric trauma?
Chest, Abdo, pelvis, long bones, head and scalp
What blood type product should be given to paediatric trauma patients?
O neg
What is the dose for PRBC for a paediatric trauma patient?
10-20ml/kg
What can you use to manage hypothermic patients?
Warmed product administration
Forced air warmers
Control environment temp
What do you need to look out for is a patient is treated with a massive transfusion?
Hypocalcaemia as blood is treated with citrate
Due to the rarity of major trauma in children, what needs to be taken into consideration?
Human factors and Crew Resource Management
What is the leading cause of death in children more than 1 year of age?
Neuro trauma - disability is common with a profound impact on functional long term outcomes
Why are children more susceptible to TBIs?
They have a larger head to body size ratio
Thinner cranial bones
Less myelinated neural tissue
Greater incidence of DAI and cerebral oedema
How quickly should a head CT be obtained within?
30 minutes of arrival
If getting a CT head on a child proves to be challenging, especially when they are distressed. What could the trauma team decide?
Whether sedation and/or intubation is necessary
What is the criteria for a head CT in a paediatric trauma patient?
Initial assessment of a GCS less than 14/ 15 for children under 1 year
Suspected open or depressed skull fracture
Tense fontanelle
Any signs of a basal skull fracture
Focal neurological deficit for children under 1 years
Presence of bruise, swelling or laceration of more that 5 cm on the head
Witnessed LOC more than 5 mins
Abnormal drowsiness
3 or more episodes of vomiting
Significant mechanism of injury
Amnesia lasting more than 5 mins
What should happen to a child who has sustained a head injury and only has 1 of the risk factors?
They should be observed for a minimum of 4 hours after the injury. If they develop and of the risk factors during that time they should have a head CT within an hour. If none of the above it’s clinical judgment as to whether they can be discharged
When discharging paediatric patients home, what needs to be considered?
Their home social situations
What is the criteria for admitting a child with a head injury?
-CT findings suggesting fractures, contusions or intra-cerebral bleed
-Signs of neurological dysfunction
-Severe headache or vomiting
-Presence of serious clotting disorders
-Difficult social conditions at home, unable to re-present quickly or a lack of a responsible adult to carry out observations after discharge
What is the result of drowning?
Primary respiratory impairment from submersion/immersion in a liquid medium
What is one of the leading causes of paediatric death globally?
Drowning
What are some of the factors that influence the risk of drowning during childhood?
Socio-economic factors
Swimming ability
Substance misuse
Pre-existing co-morbidities
What is common following drowning and may adversely affect resuscitation?
Hypothermia
What are common at temps below 30 degrees?
Arrhythmias and some may be refractory at these temps
How should arrhythmias, such as VF, be treated in a hypothermic (below 30 degrees)drowning paeds patient?
Defibrillation should be limited to 3 shocks and inotropic or anti arrhythmia drugs should not be given. If the 3 shocks are unsuccessful the patient should be rewarded to above 30 degrees where further defibrillation should be attempted
Should the dose interval for resuscitation drugs be doubled or halved between temps of 30-35 degrees?
Doubled
At what core temperature should resuscitation be continued to, especially if it can’t be raised further despite active measures?
32 Degrees
What are core rewarming techniques?
IV fluids
Warm ventilator gases
Gastric or bladder lavage
Peritoneal lavage
Pleural or pericardial lavage
Endovascular rewarming
Extracorporeal rewarming
What are external rewarming techniques?
Remove wet clothing
Supply warm blankets
Forced warm air system
Heating blankets
