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IBSc PHEM Applied Science > Pediatric trauma > Flashcards

Pediatric trauma Flashcards

1
Q

Most common cause of death and disability in childhood

A

Trauma

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2
Q

Most common trauma mechanism and most common cause of traumatic death in childhood

A

Most common - falls
Death - RTC

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3
Q

Why do children have different injury patterns and are more likely to have multi system injury than adults

A

Same kinetic energy transferred across a smaller volume

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4
Q

Children vs adult general physiological differences

A

Greater SA:volume -> incr heat loss
- hat, blanket, warmed fluids
Incr O2 extraction
Incr glucose utilisation
Smaller glycogen stores

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5
Q

Child vs adult airway differences

A

Large occiput causes neck flexion when supine
Soft trachea
Smaller airway - more likely to obstruct
Larger tongue -> obstruction more likely
Infants are obligate nasal breathers
Small Cricothyroid membrane
Funnel shaped larynx -> more likely to retain foreign body
Large tonsils and Eden oils - more likely to bleed during instrumentation

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6
Q

Why are surgical airway more difficult in kids

A

Small Cricothyroid membrane

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7
Q

Why should a pad be placed under a child’s shoulders

A

Prevents flexion of neck when supine due to large occiput

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8
Q

Why is nasal trauma particularly a problem in infants

A

Infants are obligate nasal breathers

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9
Q

Are OPs or NPs better in kids

A

OP (inserted without turn)

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10
Q

Why is bleeding more likely when using instruments while establishing airway in kids

A

Large tonsils and adenoids

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11
Q

Intubation considerations in kids

A

Narrow supraglottic region - more prone to dynamic collapse
Higher and more anterior larynx
Shorter trachea - endobronchial intubation more likely
Horse shoe shaped epiglottis

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12
Q

Why should a straight blade be used for intubation kids

A

Higher and more anterior larynx

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13
Q

Larynx position in kids and adults

A

Kids C2-3
Adults C6-7

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14
Q

What about a child’s epiglottis makes intubation more difficult

A

More horse shoe shapex

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15
Q

Child vs adult breathing differences

A

Quicker diapragm muscle failure -> apnoea more likely
Incr dependence on diapragm for ventilation
More elastic ribs - dissipate Ek to underlying structures
Mobile mediastinum - tension pneumothorax more severe
Short neck - hard to detect deviation
More likely to hear transmitted sounds on auscultation
Less able to incr vital capacity
Large stomach - prone to inflation in vent

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16
Q

tension pneumothorax issues in kids

A

mediastinum more mobile than in adults causing rapid ventilators and circ collapse
Shorter neck makes detecting tracheal deviation difficult

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17
Q

Why should you listen to a child’s chest in the axillae

A

Helps avoid issues of transmitted sounds

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18
Q

Why are kids less able to increase vital capacity

A

Chest wall circumference doesn’t change much during respiration (ribs go up and down more than in and out)
Ribs are more horizontally aligned

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19
Q

Why are kids more reliant on increasing RR in compensation

A

Less able to incr vital capacity than adults

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20
Q

Issues from inflating stomach during assisted breaths

A

Decreased lung inflation
Vomiting
Decreased venous return

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21
Q

How to prevent/manage inflation of stomach during assisted breaths

A

Ventilate to chest rise
Decompress stomach w OGT

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22
Q

Child vs adult circulation differences

A

Lower systemic vascular resistance
Infants unable to increase stroke volume
Can compensate for 30% loss in circ vol by incr HR -> hypotension is late sign
Bradycardia is ore terminal sign
Vascular access more difficult-> IO
Blood vol relatively larger but absolutely smaller

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23
Q

What aspect of cardiac output compensation can infants not do

A

Increase stroke volume

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24
Q

Why is hypotension and bradycardia late signs of decompensation in children

A

Kids can compensate for 30% loss of circ vol by increasing HR alone, so BP falling is late and bradycardia is pre terminal

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25
Q

What fluid bolus does JRCALC suggest for kids

A

5ml/kg ideally warmed

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26
Q

Why is IV access more difficult in kids

A

Smaller vessels
More subcutaneous tissue

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27
Q

Why should multiple sampling be avoided in kids

A

Smaller blood volume

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28
Q

How does circulating volume differ in kids and adults

A

Relative volume larger
Absolute volume smaller

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29
Q

Neurological differences in kids and adults

A

Larger head: body ratio - higher COG + more likely to be target
Brain less myelinated and higher water content -> incr shearing forces + seizures
Thinner cranial bones
Cranial bones more pliable and sutures may be open

30
Q

Neurological differences in kids and adults

A

Larger head: body ratio - higher COG + more likely to be target
Brain less myelinated and higher water content -> incr shearing forces + seizures
Thinner cranial bones
Cranial bones more pliable and sutures may be open

31
Q

Why are children more at risk of traumatic seizures

A

Brain less myelinated and higher water content -> increased shearing forces -> increased seizures

32
Q

Why are children more prone to brain parenchyma injury

A

More pliable cranial bones
Sutures may not be fused
Cranial bones thinner
Larger head:body so head more likely to be energy transfer target

33
Q

Abdominal differences in kids vs adults

A

More anterior liver and spleen
More horizontal diapragm pushes liver and spleen downwards
Intraabbdominal bladder
Cartilaginous rib at bottom of thorax might damage abdo structures
Larger solid organs
Less protective musculature
Less subcutaneous tissue
More mobile kidneys

34
Q

Liver and spleen differences in kids

A

More anterior
Pushes down by more horizontal liver
Larger - take up more space in abdo cavity than in adults so more likely injury target

35
Q

Does full abdo exam include PR in kids

A

No, but includes genital exM

36
Q

London major trauma indications for transfer to MTC in kids under 12

A

Traumatic death in same passenger compartment
Uninterrupted fall over twice pt height
Trapped under vehicle or large object
Bullseye or damage to A-post of car from striking pt
Bike injury causing abdo &/or groin pain (thrown from or handlebar injury)
Ejection from vehicle
Fall from or trampled by large animal

37
Q

Kids vs adults orthopaedic differences

A

Growth plates not fused - limb length deformity possible
Tenuous spinal cord blood supply
Larger head size -> greater flex/ext injury
More flexible interspinous ligaments
Smaller neck muscle mass
SCI less common but likely to be higher in young kids
Fulcrum height higher
Incomplete ossification
Larger pre dental space
Pseudo subluxation of C2 on C3
Changes in prevertebral space w resp
Flatter and more horizontal facet joints

38
Q

Why are neck Ligamentous injuries more common than fractures in kids

A

Smaller neck muscle mass

39
Q

How does SCI pattern differ between kids and adults

A

Less common in kids, but likely to be above C3 if it does happen
Adult SCI pattern from 15yrz

40
Q

Why does neck imaging in kids require specialist interpretation

A

Incomplete ossification

41
Q

What spinal level is psuedosubluxation common in kids

A

C2 on C3
In 40% kids aged 8 to 12

42
Q

What spinal level is psuedosubluxation common in kids

A

C2 on C3
In 40% kids aged 8 to 12

43
Q

Is spinal immobilisation required in kids

A

Controversial but ‘essential’ in JRCALC

44
Q

Definite requirement for spinal immobilisation in kids

A

Paralysis
Priapism
Restricted spinal rotation
Neck pain
Paraesthesia
Ptosis
Torticollis
Unexplained hypotension (even if resolved)
Down’s syndrome

45
Q

Kids vs adults psychological differences

A

Regressive behaviours more likely
Continue to grow during rehab phase
60% have personality changes at 1 yr
50% have cognitive impairment at 1 yr

46
Q

Why is ionising radiation avoided in kids

A

Higher increase in lifetime cancer risk

47
Q

Psychological Considerations when treating kids

A

Keep NOK in field of vision and earshot
Expose ‘piece meal’ to avoid embarrassment and hypothermia
Be suspicious if child doesn’t cry on vascular access
Bubbles and stickers :)

48
Q

Paediatric neurology red flags

A

Obvious extracranial head injury
Decr motor score
Pupil abnormality
Blood glucose abnormality
Recurrent vomiting
Seizure (esp more than 20 mins after event)
Irritable child

49
Q

At what age should a child be able to obey commands

A

12 months

50
Q

What injury should be assumed in a child with a head injury

A

Neck injury

51
Q

What vein may be used for access in kids less than 10 days old

A

Umbilical vein

52
Q

What veins may be used for access in children

A

Femoral vein
Saphenous vein cutdown
Umbilical vein (less than 10 days old)

53
Q

What investigation is needed after IO

A

X ray of limb after IO removed

54
Q

What medical investigations are needed in suspected non accidental injury

A

Skeletal survey
Retinal photography

55
Q

Strategies to help with age / doses for kidskin

A

Page for age cards
Use child’s clothes for age if no one can confirm age

56
Q

Important aspects of paediatric trauma mx

A

Oxygenate
IO access
BP
Keep warm
Treat pain
Correct age on pre alert

57
Q

Why should blood glucose be checked regularly in kids

A

Incr glucose utilisation
Smaller glycogen reserves

58
Q

Positioning to improve airway mx in kids

A

Pad under shoulder

59
Q

Why is a child’s larynx more likely to retain a foreign body

A

Funnel shaped

60
Q

Why is an ET tube more likely to move/dislodge when manoeuvring of transporting a child

A

Narrow supraglottic region

61
Q

What complication is more likely when intubating a child due to a shorter trachea

A

Endobronchial intubation

62
Q

What cardiac complication can be up induced by suction in a child

A

Bradycardia

63
Q

How should bradycardia in a child be treated

A

Oxygen
(NOT ATROPINE)

64
Q

How can inflation of the stomach by assisted breathing cause cardiac arrest

A

Decreased venous return

65
Q

What is a possible cause of bradycardia in children

A

Hypoxia

66
Q

Why are abdo organs more at risk in kids

A

Less abdo muscles and fat

67
Q

What sign on the abdomen is a red flag in children

A

Bruising on abdo wall

68
Q

What can be used to immobilise a small child instead of a backboard

A

Car seat

69
Q

Why should kids with Down syndrome be immobilised

A

Incr risk of subluxation of C2 on C3 or c3 on c4

70
Q

What spinal level is the fulcrum in toddlers and kids

A

Toddlers - c2-3
Kids c5-6

IBSc PHEM Applied Science (21 decks)

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