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AA1 > peds wk 4 Trauma > Flashcards

peds wk 4 Trauma Flashcards

1
Q

What is #1 cause of death in those age 1-19yrs?

A

Trauma

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2
Q

Primary cause of death/long term disability

A

Traumatic brain injury 70%,
Thoracic Injury 20%,
Abdominal Injury 10%

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3
Q

Categories of Trauma with percent

A

Blunt 90% of non-burn trauma in children,
Penetrating 10%,
Burns

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4
Q

Phases of Trauma Care

A

Primary Survey w/ concurrent resuscitation,
Secondary Survey,
Definitive Care

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5
Q

Primary Survey ABCDE’s

A

Airway:ensure patent airway,
Breathing: assess and provide adequate respiration,
Circulation: Assess and assist the circulation w/ IV fluids and CPR,
Disability: Assess neuro injury,
Expose: Remove clothing for complete exam and then take appropriate steps to prevent/treat hypothermia

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6
Q

Secondary Survey

A

Complete physical exam,
History-medical, surgical, family,
Laboratory tests,
Radiologic Imaging

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7
Q

Intubation Indications

A

Ventilation,
Oxygenation,
Aspiration Precaution

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8
Q

In ped patient relatively large tongue and larynx and glottic opening are more cephalad?

A

Yes

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9
Q

Most narrow point in the airway of ped?

A

Cricoid cartilage, DO NOT force an ETT

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10
Q

When are cuffed ETT used?

A

nicu

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11
Q

Because of shorter overall airway length and smaller diameter what is more significant and what is more likely?

A

Edema,

right mainstem intubation

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12
Q

Intubation indicated for those with

A

Respiratory compromise,
CV collapse,
Altered level of consciousness

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13
Q

Does LMA protect against aspiration of gastric contents?

A

NO, therefore should be replaced as soon as experienced hands are available

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14
Q

Why are children more likely to sustain cervical neck injuries above c3?

A

because of neck musculature, their disproportionately large head size, and the elasticity of their supporting structures

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15
Q

Why is it difficult to rule out a spinal cord injury?

A

50% of these injuries exist in the absence of radiographic findings.

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16
Q

What should you always assume with initial airway management?

A

A spinal cord injury until a CT scan can be obtained confirming there is not

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17
Q

How should intubation with c-spine injury be done

A

Manual inline axial stabilization (MILS),
avoid head lift or chin lift maneuvers,
Direct laryngoscopy with RSI, fiberoptic bronch, bullard laryngoscope, etc, are options,
Glidescope common.

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18
Q

What can happen to childrens tongue when dehydrated?

A

stick to roof of mouth obstructing airway

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19
Q

Post intubation things to do

A

confirm placement via physical exam/ETCO2,
chest radiograph,
Gastric decompression w/ OGtube,
Secure the ETT

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20
Q

Secondary airway considerations-head injury

A

Head injury-increased ICP d/t injury and airway manipulation,
Basilar skill facture-AVOID nasal instrumentation!

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21
Q

Indications of basilar skull fracture

A

Rhinorrhea, otorrhea, periorbital ecchymosis

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22
Q

Secondary airway considerations-neck injury

A

crepitus may indicate tracheal or bronchial interruption,
consider intubation via flexible fiberoptic bronch in a spontaneously ventilating patient to avoid false passage of endotracheal tube

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23
Q

Difficult airway management

A

transport to OR if feasible,
ENT or General surgeon dedicated to the airway,
Inhalation induction w/ care to maintain SV,
Avoid muscle relaxants until airway secure,
Propofol/Remi can be used to facilitate short acting IV induction while blunting ICP responses and maintaining SV

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24
Q

Injuries affecting ventilation

A 
Simple tension pneumo,
Open pneumothorax,
Massive hemothorax,
Flail chest,
Pulmonary contusion
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25
Q

What is shock?

A

widespread inadequate organ and tissue perfusion

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26
Q

what is an early sign of cv compromise and impending shock?

A

tachycardia

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27
Q

tachycardia indicates at leas how much blood loss?

A

10% loss of circulating blood volume

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28
Q

How much total blood volume can be lost prior to evidence of hypotension?

A

25-35% without anesthesia on board

29
Q

Signs of inadequate peripheral perfusion

A 
tachycardia,
Delayed cap refill (>2sec.),
Weak or thready pulses,
Mottling or cyanosis,
Impaired consciousness
30
Q

Hypotension in a child should be recognized as a ____ sign of hypovolemia and hemorrhage

A

LATE

31
Q

Bradycardia is a dangerous sign indicating

A

hypoxemia, impending arrest, or increased ICP

32
Q

Hypotension is an ominous sign of impending cv collapse and indicates ___% blood volume loss (approximately ___mL/kg)

A

25%, 20mL/kg

33
Q

<20% blood volume loss and associated signs: CV, Skin, Renal, CNS

A

CV: tachycardia; weak, thready pulses
Skin: cool to touch, cap refill 2-3 sec,
Renal: Slight decreases in urine output, increase in specific gravity,
CNS: Irritable, may be combative

34
Q

25% blood loss: CV, Skin, Renal, CNS

A

CV: Tachycardia; weak, thready distal pulses,
Skin: cold extremities, cyanosis and mottling,
Renal: Decrease in urine output,
CNS: confusion, lethargy

35
Q

40% blood loss: CV, Skin, Renal, CNS

A

CV: Frank hypotension; tachycardia may progress to bradycardia,
Skin: pale, cold,
Renal: No urine output,
CNS: Comatose

36
Q

Volume resuscitation fluid bolus

A

20mL/kg LR or NS.

VERY IMPORTANT for it to be warmed and most time use LR. Can be repeated for a total of three boluses.

37
Q

Additional volume resuscitation should begin with

A

10mg/kg of blood

38
Q

if volume resuscitation does not show marked improvement further investigation is requuired for other causes like

A 
long bone fx,
pelvic fx,
pericardial effusion and tamponade(more common w/ penetrating),
tension pneumo,
intra-abdominal injuries,
ICH in infants w/ expandable fontanelles
39
Q

Vascular assess establishment

A

Peripheral-usually AC,
Central lines should be placed in femoral vessels… subclavians and neck offer too many possible complications in the acute phase,
IO needle access in all ages.

40
Q

US FAST

A

Focused abdominal sonogram for Trauma

41
Q

Disability and diagnostic evaluation scans

A

General xray, computed tomography, and sonogram

42
Q

Labs for trauma

A

CBC, Type and screen, ABG, Urinalysis

43
Q

AVPU neuro assessment during primary survey

A

Alert,
Voice, responds to,
Pain, responds to only,
Unresponsive

44
Q

Categories of facial trauma

A

soft tissue,
dental,
facial fx,

45
Q

dental trauma

A

decreasing rate throughout childhood,
loss of dentition or severe injury can hinder airway security/intervention,
may require bronchoscopy to clear debris from lower airways

46
Q

facial fx

A

least common type of facial injury in children,

nasal fractures most common type, followed by mandibular and maxillary fx

47
Q

oropharyngeal lacerations/impalement

A

falls complicated by objects in mouth,
complicated airways (difficult to work around foreign body),
agiogram should precede removal of objects depending on location

48
Q

tension pneumothorax signs and symptoms

A

diminished breath sounds,
tracheal deviation to opposite side,
hypotension, decreased lung compliance (increased PAP)

49
Q

open pneumothorax etiology

A

defect in chest wall equalizes pressure of the lung/peural space with outside environment
Treatment: cover the defect w/ an occlusive dressing and secure on three sides w/ tape

50
Q

abdominal injuries

A

cause of death 10%,
blunt trauma most common,
careful medical management usually treatment of choice,
solid organ injuries rarely require surgical intervention in blunt trauma

51
Q

TBI

A

leading cause of mortality (>70% of deaths),
mainly MVC, children<4yo 30-50% attributed to falls or abuse(non-accidental trauma),
multisystem almost always associated,
higher risk of coup-contercoup injury d/t large head and weak neck w/ high center of gravity,
also thinner cranial bones and less myelinated nerve tissue

52
Q

Phases of TBI

A 
Primary injury,
secondary injury (cerebral response to trauma),
secondary injury (systemic response to trauma)
53
Q

Goal in TBI

A

MINIMIZE EFFECTS OF SECONDARY INJURY,
low threshold for intubation,
recall suspected basilar skull fx is c/o for nasal intubation/nasal airway/gastric suction tube,
prompt treatment of shock, hypotension, hypoxemia, and hypercarbia

54
Q

Spine injuries

A

cervical spine fx occur in 7-10% of TBI,
assume vertebral/cord injury,
fulcrum of cervical mobility in the children is C2-3, while it is c5-7 in adults,
For this reason, 60-70% of ped fx occur in C1-2 in children vs 16% in adults,
ligamentous laxity also accounts for decreased incidence of fx

55
Q

4 basic mechanisms of lawnmower injuries

A

lower of mower stability,
blade contact,
layout and function of mower and controls,
running over/backing over

56
Q

urgent or emergent surgical intervention for skeletal injuries

A

complex/displaced fx,
fx complicated by neurovascular impairment,
fx complicated by limb ischemia,
open fx,
joint dislocations that cannot be reduced,
compartment syndromes

57
Q

vascular involvement with

A 
supracondylar distal humerus fx,
distal femur,
proximal tibia,
displaced pelvic fx,
knee dislocations
58
Q

NPO, gastric emptying stops at

A

time of trauma

59
Q

assume high risk for full stomach and ______ precations in all maneuvers

A

aspiration

60
Q

thiopental

A

neuro protective, direct myocardial depressant

61
Q

propofol

A

neuro protective; profound vasodilator

62
Q

etomidate

A

hemodynamic stability, neuroprotective, adrenal suppression

63
Q

ketamine

A

sympathetic outflow, not neuroprotective and can cause marked hypotension w/ increased CBF

64
Q

maintenance of anesthesia based on:

A

nature and proposed duration of procedure,
extent of injuries,
child’s venilatory, hemodynamic, and neuro status,
likelihood of post op mechanical vent

65
Q

SHOCK

A

a metabolic demand that exceeds either oxygen supply or demand

66
Q

ABL

A

up to 40% can be replaced by crystalloids

67
Q

electrolyte to give with blood

A

calcium d/t citrate binding calcium causing hypocalcemia

68
Q

FFP factors provided

A

II, V, VIII, IX, and XI and antithrombin III

69
Q

Transfusion of ____units/kg will raise the PLT count by _____

A

0.1,
20,000,
DO NOT REFRIGERATE

AA1 (7 decks)

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