the injured child Flashcards
why is injury in children important
- major trauma relatively rare
- leading cause of death and disability
- >1y/o: pedestrian trauma w/ resulting head trauma is the commonest cause of death and disability
- <1y/o: NAI is the commonest cause of death and disability
demographics of severely injured children
<1y/o - 20-25% of pts (NAI!)
lowers to ~5% between 1-10y/o
slow increase to 10-15% by 15y/o
injury mechanism - 1-15y/o
RTC
falls <2m/>2m
assault
NAI under 2y/o
other
injury type (AIS 3+)
most common - head injury (>70% pts)
then from highest to lowest % of pts:
thoracic injury
abdo injury
limb/pelvis injury
polytrauma
spinal injury
why do children get injured
interaction between:
- stage of development: anatomical, behavioural, locomotor, physiological, psychological
- environment
- those around them
things to consider:
- audio visual clues, written warnings, climbing, inquisitive nature, playing, risky behaviour
INJURY PREVENTION IS KEY
why do children injure differently
- different anatomical features
- different physiological and psychological responses to injury
- different spectrum of injury patterns
- not all children are the same: neonates → adolescents
why is the size of children important
- relatively greater amount of energy is absorbed for the same force of impact
- large SA:vol → heat loss significant in small children
- big head
skeleton in children
- imcompletely calcified
- soft and springy
- deforms rather than breaks
- poor at absorbing energy
PROVIDES LESS PROTECTION FOR VITAL ORGANS
tissues and internal organs in children
less elastic connective tissue → shearing and degloving
crowding of poorly protected vital organs
- liver, spleen and bladder and intra-abdo
- single impact can injure multiple organs
- relatively thin abdo wall
metabolism in children
thermoregulation
- little brown fat and immature shivering
- environmental considerations e.g. RTCs
hypoglycaemia
- little glycogen stored in liver
- exacerbated by hypothermia and vice versa
- develops relatively quickly in sick children
injuries patterns in children
SCIWORA - spinal cord injury w/o radiological abnormality
lap belt syndrome - abdo wall bruising from seatbelt, likely to have significant shoulder injury
what is the aim of trauma resuscitation
- restore normal tissue oxygenation ASAP
- stabilise the patient and reverse shock
- prevent early trauma mortality
damage control resus: aims to maintain circulating vol, control haemorrhage and correct the lethal triad (coagulopathy, acidosis, hypothermia) until definitive intervention is appropriate
how to approach trauma resuscitation
team work - trauma call (code red, paeds trauma call), who is involved, assign team roles, don’t forget parents
preparation
challenges
1y and 2y survey
preparation for trauma resus
WETFLAG - weight, energy, tube size and length, fluids, lorazepam, adrenaline, glucose
equipment - tubes, blood warmer, pelvic binder
major haemorrhage protocol
drug calculations
trakcare
challenges in trauma resus
communication difficulties - too young/afraid to describe symptoms, have to rely on non-verbal cues, don’t understand what is happening, good rapport essential
fear affects vital signs
distressed parents
effects on staff
vital signs in children
what type of fracture is this
buckle fracture of distal radius
what type of fracture is this
supracondylar fracture
blood in joints on left image - indicates fracture even if not visible
what type of fracture is this
greenstick fracture
what type of fracture is this and how do they tend to occur
clavicle
fall onto the hands/shoulder
what type of fracture is this
Toddler’s fracture of the tibia
growth plate injuries classification
Salter-Harris
indicates how likely they are to affect growth later in life
