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EM200 > Pediatric Injuries > Flashcards

Pediatric Injuries Flashcards

1
Q

Leading cause of death in pediatrics

A

Injury

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2
Q

Blunt or penetrating more common

A

Blunt

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3
Q

Most common cause of injuries in… - 0 to 14 yo? - 1 to 18 yo?

A

Falls in 0-14 MVA in 1-18

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4
Q

Second most common cause fatal injuries in kids 1-14:

A

Drowning

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5
Q

Second most common cause fatal injuries in kids 15-18:

A

Firearms

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6
Q

Most common traumatic injuries in pediatrics:

A

Head > extremities > torso > spine

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7
Q

Different injury responses kids have compared to adults and the anatomic / physiological reason for it:

A

(1) Multiple injuries are more common –> Overall smaller body size / more compact organs (2) Higher frequency of head trauma –> proportionally bigger heads. (3) Greater propensity for spinal cord injuries without radiologic abnormality (SCIWORA) –> Flatter facets joints, more elastic cervical ligaments. (4) Normal blood pressure early in shock –> high degree of compensatory vasoconstriction (5) Greater heat loss from exposed body surfaces causing them to get cold much faster –> larger body surface area/mass ratio. (6) Higher risk of intra-abdominal injury and bleeding –> abdominal organs more anterior and less subcutaneous fat

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8
Q

Main psychological differences between kids and adults and why this is important in an ER:

A
  • Fear, pain, and anxiety are more widespread. - Parental separation can cause major stress. - Stranger anxiety can cause major stress. - Lack of ability to reason. *** Especially things like widespread fear, etc, can make it difficult to determine if there is an altered mental status, or the kid is just scared.
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9
Q

Role of “Child Life Representative”

A

Person who helps calm parents and distract kids during trauma scenarios.

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10
Q

Primary Survey =

A

The life support phase of pediatric trauma care: - goal is to immediately recognize and intervene on airway compromise and unrecognized hemorrhage. - A, B, C, D, E’s

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11
Q

ABCDE in primary survey:

A

A - airway patency and C-spine B - “breathing,” oxygenation, and ventilation. C - “Circulation,” signs of shock, hemorrhage control, vascular access. D - “Disability/D-stick” pupils, AVPU, GCS, glucose stick. E - “Exposure and Environmental control” Completely undress patient while preventing hypothermia.

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12
Q

“AVPU”

A

An easier GCS Score: Alert Voice Painful stimuli Unresponsive

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13
Q

Secondary Survey =

A

head-to-toe evaluation performed after the trauma and which the examiner will yell out to the rest of the team: (1) HEENT (2) Neck (3) Chest (4) Cardiac (5) Abdomen (6) MSK (7) Genitourinary (8) Back

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14
Q

HEENT components of 2º survey:

A

Scalp eye trauma hemotympanum septal hematoma facial bone fractures dental trauma.

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15
Q

Neck components of 2º survey:

A

cervical spine tenderness subcutaneous crepitus stepoffs swelling

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16
Q

Chest components of 2º survey:

A

tenderness equal chest rise

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17
Q

Cardiac components of 2º survey:

A

Heart sounds Murmurs Rubs Gallops

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18
Q

Abdominal components of 2º survey:

A

distension tenderness BS

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19
Q

Musculoskeletal components of 2º survey:

A

swelling tenderness crepitus deformities pelvic instability

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20
Q

Genitourinary components of 2º survey:

A

Urethral bleeding Rectal exam Vaginal bleeding

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21
Q

Back components of 2º survey:

A

Tenderness Crepitus Stepoffs Swelling Axillae

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22
Q

What to do in 1º and 2º surveys if there is a change in patient status:

A

Reassess

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23
Q

A 4 yo boy darts into the street and is struck by a car. EMS arrives to find him unresponsive, pale and tachypneic but without increased work of breathing. ** What do you do next?

A

Perform 1º and 2º survey

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24
Q

Indications for intubation:

A

Intubation generally rare in peds Indicated when: - unable to control airway - decompensated shock - GCS ≤ 8

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25
Q

Method for fluid resuscitation in kids:

A

2 boluses of 20cc/kg crystalloids - if still no response move to blood

26
Q

Wadell Triad:

A

Seen in pedestrian kids hit by a motor-vehicle: (1) Closed Head Injury (2) Intra-abdominal injury (3) Mid-shaft femur fracture

27
Q

Max-normal pulse rate in: - Infants - Preschool - Adolescents

A
  • Infants: 140-160 - Preschool: 120 - Adolescent: 100
28
Q

Minimum-normal systolic BP in: - Infants - Preschool - Adolescents

A
  • Infants: 70-80 - Preschool: 70 + 2(age in yrs) - Adolescent: 90-100
29
Q

Max-normal respiratory in: - Infants - Preschool - Adolescents

A
  • Infants: 40 - Preschool: 30 - Adolescent: 20
30
Q

Reason a drop in BP is VERY concerning in pediatrics:

A

kids can ramp up their SVR a ton in cases of hemorrhage and therefore BP only drops once a significant amount of fluid has been lost.

31
Q

Best IV access in pediatrics:

A

2 IV lines

32
Q

Imaging modalities used in pediatric emergencies and relative importance:

A

Plain films - the main trauma films which include CXR, cervical spine, and pelvis.

FAST Exam - not used a ton in pediatrics

CT - head, C-spine, abdomen, pelvis

33
Q

FAST Exam in pediatrics advantages and disadvantages:

A
  • Advantages:
    • Fast
    • Inexpensive
    • Non-invasive
    • Radiation
  • Disadvantages:
    • Sensitivity poor in peds
    • Not good for visceral injuries
34
Q

Pediatric Trauma – Case 1

Findings

  • Radiology:
  • Chest: Normal
  • AP pelvis: Normal
  • CT head: Normal
  • CT C – spine: Normal

• CT abdomen: Grade II liver and spleen lacerations; moderate blood in peritoneal cavity; renal contusion but bilaterally functioning kidneys.

Patient has been stabilized with 40 cc/kg of crystalloid and 10 cc/kg of PRBC’s.

Patient is more alert, slightly agitated.

Does this patient need operative management?

***Next step in this patient:

A

No, most blunt trauma solid organ injuries can be treated without operation with careful management in the ICU.

Additionally, this patient is clearly improving and hemodynamically stable.

35
Q

Pediatric Trauma – Case 2

11 yo girl falls off skate board and struck her head. May have had brief LOC. Comes into the house and mother notes an abrasion and contusion on her forehead and acting dazed.

Vomits several times.

Previously healthy; no other obvious injuries.

On arrival in ED:

  • Alert, GCS 15.
  • Has amnesia about events around fall. • No C – spine tenderness
  • No other obvious injuries

(1) Does this child need a CT scan?

**(2) What other investigations, if any? **

A

(1) No great consensus on this, but in this patient we probably should since she did experience LOC.
(2) Take a good history and physical because this can really parse-out whether the patient should receive a CT or not:

36
Q

Leading cause of trauma death and disability:

A

TBI

37
Q

ICI prevalence with GCS of 15, 14, and 13:

A

15 - ICI prevalence of 2-3%

14 - ICI prevalence of 7-8%

13 - ICI prevalence of 25%

38
Q

LOC an independent preditor of ICI?

What is an idependepent predictor of ICI?

A

LOC is not

Seizure is

39
Q

Typical mechanism of ICI:

A

Fall

40
Q

Patients at greatest risk of TBI:

A

Infants due to very large head

41
Q

Rate of TBI from abuse:

A

25-30% of BHT in kidsn younger than 2yrs are from abuse

10% of all infants in ED for head trauma have been abused

42
Q

Hallmark of history in abused kids:

A

Parents can’t recall the history

43
Q

Sign to look for in patients with otherwise asymptomatic TBi:

A

scalp hematoma

44
Q

Risk of CT scanning kids:

A

Higher risk of lethal and non-lethal malignancies

45
Q

Signs and symptoms in potential TBI patient over 2yo which indicate need for CT

A

AMS

LOC

Hx of Vomiting

Mechanism of Injury

Signs of basilar skull fracture

Severe headache

46
Q

Signs and symptoms in potential TBI patient younger than 2yo which indicate need for CT

A

AMS

Scalp Hematoma

LOC greater than 5 seconds

Mechanism of injury

Palpable or skull fracture

Acting normally per parent

47
Q

How bones and other musculoskeletal structures differ in kids and what this means in terms of injury types:

A

Ligaments are stronger than bones - fractures are more common than sprains.

Thick and strong periosteum - unique fractures occur such as “buckle,” “greenstick,” and “bowing.”

Active periosteum - promotes callus, union, remodeling

Growth Plates - fractures are common and cause developmental issues.

48
Q

What you should always do for kids before you perform musculoskeletal assessment for fractures:

A

Procedural sedation

49
Q

Radiographic Eval of Fractures:

What needs to be scanned?

Splints?

Next step if fracture found?

A

Joints above and below fracture need to be scanned in addition to the fracture.

Splint should be removed before scan, but given analgesia/sedation beforehand.

Call ortho if fracture found

50
Q

Features of fracture description:

A

Anatomic location (physeal involvement?)

Open vs closed

incomplete vs complete

Displacement and Angulation

51
Q

Types of position and alignment combos for fractures:

A

Good position and alignment

Angulated with little displacement

Completely displaced with good alignment

Displaced and angulated

52
Q

Describe the different Salter-Harris Classifications:

A

The fractures are more severe as you move from I to V

53
Q

Buckle Fracture =

A

AKA Torus (“swelling”) fracture

There is a buckling of the cortex of the bone causing a swelling.

The fracture happens as force is placed on the longitundinal axis of the bone and causes buckling.

It typically happens at the distal radius.

54
Q

Boxer’s Fracture =

A

fracture of 4th and/or fifth metacarpal after punching something.

Presents with finger malrotation

55
Q

Most common pediatric elbow fx:

A

Supracondylar fracture

56
Q

Supracondylar Fractures

Part of exam which is most important:

Types of fractures:

A

neurovascular exam is very important.

Types I-III

57
Q

Type I Supracondylar Fracture

Other name?

Radiographic signs?

Treatment?

A

Gartland Type

Fat pad and periosteum are altered.

Posterior elbow splint

58
Q

Type II Supracondylar Fracture

Define

Management:

A

Displaced with the posterior periosteum intact and anterior humeral line displaced.

Ortho consult–they will perform open or closed reduction with percutaneous pin placement

59
Q

Type 3 Supracondylar Fractures:

Define

Complications

Management

A

displaced fracture with disruption of anterior and posterior periosteum–loss of contact between fragements.

Neurovascular compromise or compartment syndrome.

Ortho consult

60
Q

Avulsion Fractures:

Etiology

Most common sites

Treatment

A

Sudden traction forces by muscles result in avulsion of apophysis

Ischial tuberosity > ASIS > AIIS > Lesser trochanter > Iliac Crest

Treat with non-weight bearing crutches

61
Q

Toddler’s Fracture

  1. Define
  2. Cause
  3. Presenting signs and symptoms
  4. Exam findings
  5. Treatment
A
  1. Non-displaced spiral or oblique fx through the distal 3rd of the tibia
  2. Unwitnessed fall / minor trauma caused by trying to turn around too quickly.
  3. Limp / refusal to walk
  4. Exam will be normal except pain on gentle twisting of the LE or heel tap.
  5. Treat with short or long leg cast for 3-4 weeks, and an ortho follow-up in 1 week since incident.

EM200 (15 decks)

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