Pediatric Trauma

Question 1

True or false

 Pediatric trauma occurs in a bimodal age distribution, with peak incidences in toddlers and adolescents

Answer 1

True

Question 2

True or false

Family/caregiver presence during resuscitation is an important standard practice in pediatric care

Answer 2

True 

Question 3

When anticipating the arrival of a critically injured child, consider drawing up sedation and intuba- tion drugs beforehand using the “3:2:1 rule” which is

Answer 3

“3:2:1 rule”: fentanyl 3 micrograms/kg IV, ketamine 2 milligrams/kg IV, and rocuronium 1 milligram/kg

Question 4

True or false

Cardiac output is mediated primarily by heart rate in children as opposed to stroke volume in adults

Answer 4

True

Question 5

True or false

hypotension is a very late and ominous sign of cardiovascular compromise in children

Answer 5

True

Question 6

The mean systolic blood pressure in children 1 to 10 years of age can be estimated using the following formula: 

Answer 6

90 + (2 × age) mm Hg

Question 7

hypotension can be estimated as

Answer 7

systolic blood pressure less than 70 + (2 × age) mm Hg.

Question 8

True or false

stress-induced hyperglycemia is common in the set- ting of polytrauma, hypoglycemia can occur in younger children and should be treated promptly

Answer 8

True

Question 9

approach to the primary survey while addressing life-threatening injuries should be employed in all injured children

Answer 9

“(C)ABCDE” (catastrophic bleeding, airway with cervical spine motion restriction, breathing, circulation with hemorrhage control, disability, exposure)

Question 10

True or false

In a spontaneously breathing child with a partially obstructed airway, use a jaw-thrust maneuver with bimanual in-line spinal motion restriction to open the airway, suction secretions and debris, and apply supplemental oxygen.

Answer 10

True

Question 11

For infants and toddlers, placement of a__________ layer of padding below the entire torso may be required to maintain neutral alignment of the spine

Answer 11

1- to 2.5-in.

Question 12

Indications for endotracheal intubation in the trauma patient include the following:

Answer 12

1. Glasgow Coma Scale score <8 or lack of airway protective reflexes
2. Respiratory failure due to inadequate oxygenation or ventilation (e.g., pulmonary contusions, large pneumohemothoraces, chest wall or diaphragm injuries)
3. Impending airway comprise (e.g., facial burns, inhalation injury, expanding neck hematoma)
4. Lack of neuromuscular respiratory drive (e.g., cervical spinal cord injuries)
5. Significant hypovolemia with depressed sensorium
6. Unstable patients in need of CT imaging, angioembolization, or operative intervention
7. Transport of critically injured patients to another institution, espe- cially over long distances

Question 13

_____________ is the induction agent of choice in hypotensive patients and may improve cerebral blood flow in children with raised intracranial pressure.

Answer 13

Ketamine

Question 14

____________ reduces cerebral blood flow, intracranial pressures, and cerebral oxygen consumption, while maintaining arterial blood pressure, and may be considered in children with severe traumatic brain injury.

Answer 14

etomidate

Question 15

Consider premedication with__________ in infants <1 year of age because they are at risk for bradycardia in response to both laryngeal stimulation and hypoxia

Answer 15

atropine sulfate

Question 16

the preferred temporizing technique for oxygenation

Answer 16

needle-jet insufflation via the cricothyroid membrane

Question 17

lifesaving surgical cricothyrotomy has been suc- cessfully performed in older children in whom the cricothyroid mem- brane is easily palpable (usually by ____ years of age)

Answer 17

12

Question 18

tension pneumothorax, immediately perform a needle thoracostomy by placing a 16- to 18-gauge IV catheter in the ________________

Answer 18

midclavicular line just above the third rib

Question 19

in overweight children or muscular adolescents, consider placing a catheter between____________

Answer 19

the fourth and fifth ribs at the anterior axillary line

Question 20

consider inserting a__________________ in stable children with isolated pneumothoraces

Answer 20

pigtail-type chest tube by Seldinger method

Question 21

True or false

infants and toddlers are predominantly diaphragmatic breathers and are highly sensitive to increased intra-abdominal pressure. Early gastric decompression with an orogastric tube can significantly improve their work of breathing.

Answer 21

True

Question 22

___________ and ____________ are often the only signs of circulatory compromise

Answer 22

Tachycardia, poor skin perfusion

Question 23

Other important signs of blood loss include (5 points)

Answer 23

WEAKENING of peripheral PULSES,
MOTTLED skin,
COOL extremities relative to the torso,
altered SENSORIUM including dulled response to pain, and NARROWING of the pulse pressure to <20 mm Hg

Question 24

Ideally, place two proximal large-bore IV catheters, but limit attempts in the critically injured child and proceed to intraosseous access if unsuccessful after_____________

Answer 24

90 seconds

Question 25

Recently, there has been a move away from crystalloid resuscitation in adult hemorrhagic shock in favor of a “damage control resuscitation” approach, with includes early administration of____________

Answer 25

blood products

Question 26

“damage control resuscitation”

goal of which is to 

Answer 26

minimize the
1. dilution of clotting factors,
2. tissue edema, and
3. acidosis
associated with excessive crystalloids, which are thought to worsen trauma-induced coagulopathy

Question 27

excessive crystalloids in pediatric trauma (in excess of _____________) are associated with increased intensive care and ventilator days.

Answer 27

60 mL/kg/d

Question 28

children may be relatively fluid tolerant as com- pared to adults and usually tolerate initial boluses of ____________

Answer 28

10 to 40 mL/ kg

Question 29

Children in compensated hemorrhagic shock should be given an initial bolus of____________ of warmed crystalloids.

Answer 29

20 mL/kg (10 to 40 mL/kg)

Question 30

If their condition does not improve, early transition to weight-based blood product resuscitation is advised __________________

Answer 30

(10 to 20 mL/kg of packed red blood cells for children <40 kg)

Question 31

True or false

aggressive blood component replacement is not a substitute for definitive surgical control of bleeding

Answer 31

True

Question 32

True or false

Permissive hypotension, to prevent clot disruption, is not currently recommended in children given that hypotension is a late finding of shock and the high incidence of concomitant traumatic brain injury in polytrauma victims.

Answer 32

True

Question 33

True or false

Massive transfusion protocols provide balanced ratios of red blood cells, plasma, and platelets with the goal of minimizing the coagulopathy associated with significant hemorrhage.

Answer 33

True

Question 34

True or false

tranexamic acid should be strongly considered within 3 hours of injury in adolescents as well as children of all ages requiring a blood transfusion

Answer 34

True

Question 35

simpler and validated method to assess mental status in children is by using the____________, which is currently recommended by the pediatric advanced life support guidelines

Answer 35

AVPU score

Question 36

True or false

Be mindful that pain is often undertreated in children and ensure that appropriate analgesics and sedatives are given. Intranasal medications or inhaled NO nitrous oxide can be used prior to establishing IV access, and children, as adults, can benefit from regional blocks for musculo- skeletal injuries

Answer 36

True

Question 37

True or false

After the primary survey is complete and life-threatening injuries have been addressed, perform a secondary survey. This includes an AMPLE history (allergies, any relevant medications, past medical history, time of last meal, and events leading up to the trauma), a “head to toe” examination, and completion of adjunctive laboratory or imaging tests not already performed.

Answer 37

True

Question 38

A promising score currently being prospectively validated in polytraumatized children is the B.I.G. Score __________. A score of________ accurately predicts children with a high probability of survival and allows physicians to rapidly recognize the degree of physi- ologic derangement.

Answer 38

(base deficit + [2.5 × INR] + [15 – Glasgow Coma Scale score])

<16

Question 39

True or false

Due to anatomic and physiologic differences between children and adults, up to 30% of children with solid organ injury have no demonstrable free fluid on FAST, decreasing the sen- sitivity of this exam for solid organ injuries and limiting its negative predictive value, particularly in hemodynamically normal patients.

Answer 39

True

Question 40

is the gold standard for evaluation of acute intracranial bleeding, pulmonary parenchymal or great vessel injuries, solid organ injuries, and pelvic injuries.

Answer 40

CT imaging

Question 41

ALARA

Answer 41

(as low as reasonably achievable) principle

Question 42

Two of the most commonly used scores are the _____________ and the _____________

Answer 42

Pediatric Trauma Score

Revised Trauma Score

Question 43

Revised Trauma Score of ______ or a Pediatric Trauma Score of _______ should prompt transfer to a pediatric trauma center

Answer 43

<12

<8

Question 44

Indications for Transfer to a Pediatric Trauma Center

Physiologic criteria

Answer 44

Question 45

Indications for Transfer to a Pediatric Trauma Center

Anatomic injury

Answer 45