Pediatric Trauma Flashcards
What is the most common cause of death in children of all ages?
Injuries associated with MVCs
-then in following order: drowning, house fires, homicides, falls
Why are children at higher risk for injury from a trauma than adults?
- Smaller body mass means energy impacted from falls/objects such as fenders or bumpers results in greater force being applied per unit of body area
- Less fat/connective tissue thus less protection from trauma
- Closer proximity of multiple organs so multiple injuries more commonly seen than in adults
- Large head making them at higher risk for head trauma
- Higher body surface area to body mass thus can lose heat quickly and become hypothermic faster
What are the main differences between an adult and a pediatric airway?
Pediatric airway:
- Larger soft tissues in oropharynx (tongue/tonsils)
- Anterior and cephalad larynx in the neck
- Short trachea length
- Narrowest point in airway is at cricoid cartilage (in adults, narrowest point is the glottis at the vocal cords)
How do you calculate ETT tube size?
-what about ETT intubation depth?
ETT tube size: (Age/4) + 4
ETT tube depth: 3 x tube size from the gums (ie. a 4.0 ETT is properly positioned at 12 cm from the gums)
How should an oral airway be inserted into a child’s mouth?
Do not use the inserting backwards/then rotating 180 degrees technique since this may cause significant trauma to the palate
Instead use a tongue depressor to depress the tongue and insert the oral airway directly into the oropharynx
Are there still concerns about use of cuffed ETT causing necrosis at the cricoid cartilage?
NO! This is no longer a concern due to improved design of the current cuffs. So when possible, used cuffed ETT so you can adjust for leak
What is the DOPE mnemonic for an intubated patient who acutely deteriorates in ventilation/oxygenation?
Displacement
Obstruction
Pneumothorax
Equipment failure
What is an equation to estimate a child’s weight?
(age x 2) + 10
What are possible complications of an IO?
- Osteomyelitis
- Iatrogenic fracture of the bone
- Cellulitis
- Compartment syndrome
What is the current recommendation for fluid resuscitation in a child with hemorrhagic shock?
- Give 20 ml/kg NS bolus
- If still unresponsive, move to blood - 10-20 ml/kg PRBCs + 10-20 ml/kg FFP and platelets as part of pediatric massive transfusion protocol
What are the three responses to fluid resuscitation in a pediatric trauma?
- Responders: children who are stabilized with crystalloid fluid only. Don’t need blood.
- Transient responders: initial response to crystalloid and blood but then deteriorate
- Non responders: no response to crystalloid or blood transfusion
***Transient responders and nonresponders are candidates for prompt infusion of additional blood products, activation of a mass transfusion protocol, consideration for early operation
What factors increase heat loss in pediatric patients?
- Larger body surface area to mass ratio
- Thinner skin
- Lack of fat/subcutenaous tissue
- Increased metabolic rate
What are the anatomical differences between a pediatric vs adult spine?
Spine in children:
- Interspinous ligaments and joint capsules are more flexible
- Vertebral bodies are wedged anteriorly and tend to slide forward with flexion
- The facet joints are flat
- Children have relatively large heads compared with their necks and the fulcrum is higher in the cervical spine so there are more injuries at the level of C1-C3
- Open growth plates
- Forces applied to the upper neck are relatively greater than in the adult
What is pseudosubluxation of C2-C3?
-how can you differentiate between pseudosubluxation and true cervical spine injury?
Anterior displacement of C2 on C3 = this is totally normal and can occur in up to 40% of children < 7 yo
- pseudosubluxation = more pronounced by flexion of the C spine so repeat the films with the child’s head in a neutral position and the pseudosubluxation should disappear
- also true C spine injury should have soft-tissue swelling at that area, muscle spasm, step off deformity or abnormal neuro exam findings
True or false: If spinal cord injury is suspected based on history or results of a neuro exam, a normal spine xray cannot exclude significant spinal cord injury
TRUE!!! This is known as SCIWORA (Spinal cord injury without radiologic abnormality)
-when in doubt, assume that an unstable injury exists and limit spinal motion/obtain a consult
