Pediatric Trauma

Question 1

What anatomical differences make children more susceptible to head injuries?

Answer 1

1. Childrens head is large and heavy in relation to the rest of their body
2. Center of gravity is shifted towards the head
3. Screws with balance and coordination

Question 2

Describe sudden infant death syndrome

Answer 2

Sudden death of infants less than 1 year of age which remains unexplained

Question 3

When is SIDS more likely to happen?

Answer 3

70% of victims are found early in the morning

Question 4

At what age are SIDS deaths most common?

Answer 4

between 2 and 4 months old

Question 5

Why does SIDS correlated with ages 2-4 months?

Answer 5

Correlates to significant changes in sleep organization and modulation of the brainstem

Question 6

What is the formula for cerebral perfusion pressure?

Answer 6

CPP=MAP-ICP

Question 7

What is the normal ICP for infants, children and adults?

Answer 7

Infants = 40 mmhg
Children = 50 mmhg
Adult = 60-80 mmhg

Question 8

What are the four types of intracranial hemorrhage?

Answer 8

Subdural, epidural, subarachnoid, intraparenchymal hematomas

Question 9

What raises suspicion of non accidental trauma?

Answer 9

1. Intercranial hemorrhage
2. Lethargy, vomiting and seizures
3. retinal hemorrhages and subdural hematomas

Question 10

Why would a skeletal survey be done when NAT is suspected?

Answer 10

Multiple fractures correlate to NAT and fractures take longer to heal in PEDs so there could be evidence of sustained abuse

Question 11

Define immersion

Answer 11

to be covered by water ie face and airway

Question 12

Define submersion

Answer 12

Entire body is underwater

Question 13

What constitutes a warm water drowning? Cold water drowning?

Answer 13

> 68 Degrees = warm water
<68 degrees = cold water

Question 14

What is correlated drowning in pediatrics?

Answer 14

high incidence of ARDS and respiratory distress

Question 15

What is the result of liquid aspiration?

Answer 15

surfactant washout and impaired gas transfer

Question 16

What does dysfunction of the sympathetic nervous system result in?

Answer 16

Tachycardia
hypertension
tachypnea
agitation
muscle rigidity

Question 17

How many exams should be perfomed to determine brain death?

Answer 17

2

Question 18

What are the apnea test requirements to confirm brain death?

Answer 18

1. Documentation of an arterial PaCO2 > 20 mmHg from baseline
2. PaCO2 > 60 with no respiratory effort during the testing period

Question 19

Describe the apnea testing guidelines

Answer 19

1. Preoxygenate the patient
2. Achieve normal PaCO2 with baseline ABG
3. Continuous monitoring of vital signs and observation of respiratory effort
4. ABGs should be obtained q-minute

Question 20

When is an apnea test complete?

Answer 20

1. Respiratory effort witness
2. PaCO2> 60
   PaCO2 > 20 from initial ABG

Question 21

What is the role of the RT during apnea testing?

Answer 21

Eliminate back up ventilation
Confirm trigger sensitivity
Alarms off
Insert oxygen into ETT

Question 22

When should the child be placed back on ventilatory support?

Answer 22

If SpO2 drops below 85%
Hemodynamic instability limits completion of apnea testing
A PaCO2 level of >60 mmHg cannot be achieved