S21C251 - Trauma in Children

Question 1

Primary Survey: airway

Answer 1

• secure and protect airway

- stabilize c-spine

Question 2

Primary Survey: breathing

Answer 2

• apnea: PPV with bag-valve-mask
• hypoxia: supplemental O2
• tension pneumo: needle decomrpession
• massive hemo: chest tube
• open penumo: occlusive dressing

Question 3

Primary Survey: circulation

Answer 3

• hypovolumia: fluids/blood 20cc/kg x3 of NS, if not improving then give PRBC in 10cc/kg boluses
• pericardial tamponade: fluid bolus, pericardiocentesis, thoracotomy
• cardiac arrest: CPR

Question 4

Primary Survey: disability

Answer 4

SCI: immobilize
cerebral herniation: mild hyperventilation, mannitol 0.5-1g/kg (temporary effect)
-elevate head of bed for elevated ICP
-check pupils and ask them to move their fingers and toes

Question 5

Primary Survey: exposure

Answer 5

• hypothermia: warm fluids, external warming

- hemorrhaging wound: pressure

Question 6

Massive hemothorax in peds:

Answer 6

Defn:

• initial drainage >15cc/kg
• or if output exceeds 4cc/kg/h

-if criteria met, consider surgical thoracotomy

Question 7

Seizure after TBI

Answer 7

• 5% of pts will have one
• half of these will go on to have further seizures and of those, half will be frequent and half will be occasional
• only 50% of pts with post-traumatic seizure have an abnormal CT
• if sz lasts a few minutes or pt has 2 sz then start anticonvulsant tx
• consider prophylactic anticonvulsants if GCS

Question 8

Head CT

Answer 8

0-2yo: if low-energy mechanism and no symptoms >2h after injury, observation can be used

> 2yo: CT if severe Sx of head injury, altered mental status, multiple injuries, penetrating injury, suspected nonaccidental

• those with negligible risk do not need a CT: normal exam, no LOC, no symptoms
• symptoms include: amnesia, h/a, n/v, lethargy, facial injury, Sz

Question 9

SCIWORA

Answer 9

Spinal Cord Injury w/o radiographic abnormality

• 66% of SCI in children have no abnormal radiogrphic findings
• if transient or persistent symptoms such as paresthesias or weakness occur, imaging should be performed
• if child has signs/symptoms of a SCI and CT is normal then perform MRI
• do not do flex-ex if suspecting a SCI

Question 10

Approximate guid for tube size in children:

Answer 10

NGT: ETTx2
Foley: ETT x2
Chest tube: ETT x4

Question 11

Pediatric Trauma: abdomen

Answer 11

• nl u/a with nl physical exam has a NPV of 100%
• gross heamturia requires CT
• other indications for abdo CT: tenderness, distension, bruising, vomiting, hematuria, neuro obtundation, falling Hb, absent bowel sounds

Question 12

Pancreatic Trauma

Answer 12

• handlebar injuries are the common cause
• symptoms often delayed, high index of suspicion
• CT has 85% sensitivity of identifying pacreatic injury in the acute setting, IV and PO contrast should be used

Question 13

Bowel Trauam

Answer 13

• jejunum most frequently injured, then ileum, then cecum

- ** child with tender abdomen requires observation and serial physical exams b/c CT scans can not exclude bowel injury