Pediatric Trauma

Question 1

What are anatomical differences important to pediatric (vs. adult) trauma? (6)

Answer 1

1) Head differences – higher head:body, less myelination in the brain, cranial bones thinner –> more serious HI
2) More ant liver/spleen, less musculature, subcut tissue – organs more susceptible to injury
3) Kidneys more mobile, less protected – more susceptibel to decel injury
4) Chest wall more elastic – allows for pulm. injury w/o skeletal inj
5) Growth plates not closed – Salt-type # –> limb-length abn
6) More tenuous SC blood supply, great vertebral column elasticity – predisposes to SC inj w/o radiographic abn (SCIWORA)

Question 2

Why is hypothermia of particular concern in peds trauma? (6) How do you compensate in treatment? (3)

Answer 2

Contributes to:
- metabolic acidosis
- negative inotropic effects
- neg. chronotropy
- neg. catechol. responsiveness
- neg pltlt fxn
- neg drug clearance (hep + renal)
Requires:
-- higher IVF req
-- higher O2 extract'n, consumption
-- higher glucose utilization

Question 3

What should be suspected / considered in pediatric trauma with tachycardia? What other sign(s) might be present?

Answer 3

Compensated shock

– look for extremity perfusion (Warm, mottling, cap refill)