The Injured Child Flashcards
Why is trauma an issue?
- Commonest cause of death from age 5 to 50
- M>F 3:1 (death by injury)
- Can cause multi-system injury
- Early intervention can prevent death but prevention of incident is always better
What type of trauma is more common?
Blunt»> penetrating
Why do children sustain injuries?
- Development (anatomy, behaviour, locomotor, physiological and psychological)
- Environement (is it child friendly?)
- Those around them
- More likely to take risks
- Cannot necessarily understand warnings
- Inquisitive in nature
What type of injuries do children sustain?
- Fractures
- Wounds
- Burns and scalds
- Head injuries
- Drowning
- Other
What types of fractures can occur in children?
- Buckle
- Greenstick
- Clavicular fractures
- Toddler fractures
- Growth plate injuries
What are buckle fractures?
- Most common type seen in paediatrics
- Bone buckles due to plasticity of child bones
What are greenstick fractures?
- Bone fails in compression leading to hinge type fracture
- Z-shaped deformities can occur due to the tendons pulling
Why do clavicular fractures differ from other types of fractures?
- Membranous calcification so heals like a skull bone
- Only 1 x-ray usually required (do not need multiple views)
What are toddler’s fractures?
- Fractures that occur usually on the shin .
- Related to children starting to walk, tripping and twisting their ankles
What are growth plate injuries?
- Growth plate point of weakness in long bone so can be injured
- Often-break around the growth plate
What classification system is used for growth plate injuries?
Salter-Harris classification
What is important to establish with penetrating wounds?
Base and depth of wound
What should be your first thought when you see as shocked patient that has been in a fire?
What other injuries does this person have
-Shock is a late presentation. Early shock is an indicator of other injuries
What confounding factors are there in trauma?
- Cold
- Alcohol
- Drugs
- Hypoglycaemia
Why does a child’s size influence injuries sustained?
Smaller target
-Relatively greater amount of energy is absorbed for the same force of impact
Large surface area:volume ratio
-Heat loss significant in small children
Relatively large head
-Easily injured
Smaller mass
- Drug doses and fluid requirements differ
- Different equipment and techniques
Why does a child’s skeleton influence injuries sustained?
Incompletely calcified so it is:
- Soft
- Springy
- Deforms rather than breaks
- Poor at absorbing energy
Provides protection to vital organs
Why does a child’s ‘insides’ influence injuries sustained?
Less elastic connective tissue
-Shearing and de-gloving
Crowding of poorly protected vital organs
-Liver, spleen, bladder and intra-abdominal
How does a child’s metabolism influence injuries sustained?
Thermoregulation
- Little brown fat and immature shivering
- Pokilothermic
- Environmental considerations e.g. RTCs
Hypoglycaemia
- Little glycogen stored in liver
- Exacerbated by hypothermia and vice versa
- Develops quickly in sick children
How can you establish the mechanism of injury?
- Good history
- Pictures, videos etc.
- Do the injuries fit with the story?
Give examples of injury patterns.
- SCIWORA
- Lap belt syndrome
- Waddell’s triad : child hit straight on by car
What does SCIWORA stand for?
Spinal cord injury without radiological abnormality
What is Waddell’s triad?
- Femoral fracture
- Head injury
- Trunk injury
What are the long term effects of injury on children?
Psychological recovery from trauma
Effects on normal growth and development
-Classica example Salter Harris type 5 which cannot be detected until growth arrest occurs
What are the normal vitals for <1 years?
RR
30-40
HR
110-160
SBP
70-90
What are the normal vitals for 2-5 years?
RR
25-30
HR
95-140
SBP
80-100
What are the normal values for 5-12 years?
RR
20-25
HR
80-120
SBP
90-110
What are the normal values for >12 years?
RR
15-20
HR
60-100
SBP
100-120
What can cause respiratory depression?
- Poisoning
- Convulsions
- Raised ICP (head injury, acute encephalopathy)
What can cause circulatory failure?
Fluid loss
- Gastroenteritis
- Burns
- Trauma
Fluid malabsorption
- Sepsis
- Anaphylaxis
- Heart failure
What is the 1st peak of deaths?
- Die on scene
- Un-survivable major vessel or brain injury
Prevention is the only treatment
What is the 2nd peak of death?
- Die from significant ABCD problems unless adequately resuscitated
- Platinum 10 minutes and golden hour
What is the 3rd peak of deaths?
- Delayed deaths despite resuscitation, surgery and ICU
- Due to multi-organ failure or sepsis usually
What is the aim of trauma resuscitation?
To restore normal tissue oxygenation as quickly as possible
What is the universal approach to trauma
- Cat haem control
- Airway with c-spine
- Breathing and ventilation
- Circulation with haem control
- Disability and glucose
- Exposure and environment
What type of injuries should be identified during a primary survey?
ATOM FC
- Airway
- Tension pneumothorax
- Open pneumothorac
- Massive pneumothorax
- Flail chest
- Cardiac contusions
What is the order of trauma care?
- cABCDE
- Primary survey
- Secondary survey
- Emergency treatment
- Definitive care
- Reassessment
How do you determine a child’s weight?
< 1 year
(0.5 x age in months) +4
1-5 years
(2x age) +8
6-10 years
(3x age) + 7
What system can be used to estimate a child’s weight?
Broselow system
