The Injured Child Flashcards
In terms of paediatric trauma:
- Which gender more affected?
- Blunt or penetrating more common?
- How is death prevented?
- Boys are 3 times more likely to die from trauma than girls are.
- Blunt trauma is more common than penetrating.
- Early intervention prevents death, but prevention itself is always the best cure.
Why do children sustain injuries?
Interactions between:
-
Stage of development
- Anatomical, behavioural, locomotor, physiological, psychological
- Their environment
- Those around them
What injuries to children sustain?
- Fractures
- Such as radial, clavicle, tibia, “greenstick”, growth plate injuries
- Wounds
- Such as scissor wounds.
- Burns and Scalds
- Head Injury
- Drowning
What are some variables that can play a role in paediatric trauma?
- Cold
- Alcohol
- Drugs
- Hypoglycaemia
Why do children injure differently to adults?
Children are not just little adults.
- Different anatomical features.
- Different physiological and psychological responses to injury.
- Different spectrum of injury patterns.
Children themselves are obviously also very variable. Neonates, infants, toddlers, children and adolescents with all potentially present differently.
What features of a child’s size plays a role in the impact of trauma?
-
Smaller target
- Relatively greater amount of energy is absorbed for the same force of impact.
-
Large SA:VRatio
- Heat loss is significant in children
-
Relatively large head -
- which is easily injured.
- Smaller mass
- Drug doses and fluid requiremnets differ.
- Different equipment and techniques.
What features of the child’s skeleton are important in the impact of trauma?
Incompletely calcified
- Soft
- Springy
- Deforms rather than breaks
- Poor at absorbing energy
Provides less protection for vital organs.
What implications in terms of trauma in regards to children’s “inside”?
- Less elastic connective tissue
- Shearing and degloving
- Crowding of poorly protected vital organs
- Liver, spleen, bladder are intra-abdominal.
What metabolism differences are important in paediatric trauma?
Thermoregulation
- Little brown fat and immature shivering
- Poikilothermic - variable internal temp.
- Environmental considerations - e/g/ RTCs
Hypoglycaemic
- Little glycogen stored in Liver
- Exacerbated by hypothermia and vice versa.
- Develops quickly in sick children.
How can you best find out the mechanism of injury?
- Take good history
- “read the wreckage” - look at the injury seen.
- Does the injury fit with the findings?
- Non Accidental Injury
What are 2 common injury patterns seen in Paediatric truma?
- SCIWORA
- Spinal cord injury without radiological abnormality.
- Lap Belt Syndrome - injury inflicted by a seat belt.
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How do children respond to an injury?
- Communication Difficulties
- Too young or afraid to describe symptoms.
- Relying on non-verbal clues becomes very important.
- Good rapport is essential.
- Fear also impacts vital signs
- Very important to remember that the parents will likely be very distressed and in more severe cases there will be effects on staff.
What are some of the long term effects of Paediatric Trauma?
- Psychological recovery from trauma.
- Effects on normal growth and development.
What are the causes of Respiratory Obstruction which can lead to Resp. Failure in Children?
- Birth asphyxia
- Croup
- Epiglottitis
- Foreign Body Inhalation
- Bronchiolitis
- Asthma
- Pneumothorax
What are the causes of respiratory depression that can lead to respiratory failure in children?
- Poisoning
- Convulsions
- Raised ICP
- Head injury
- Acute encephalopathy
- Meningitis
- Encephalitis
