The injured child Flashcards
Which gender is most likely to die from injury?
Boys 3x more likely to die from injury than girls
What type of trauma is more common?
Blunt trauma > penetrating trauma
What injuries do children sustain?
Fractures Wounds Burns and scalds Head injury Drowning
Associations with injury in children
cold
alcohol
drugs
hypoglycaemia
Why do children injure differently?
Different anatomical features Different physiological and psychological responses to injury Different spectrum of injury patterns Size Skeleton Inside the body Metabolism
Size affecting injuries in children
Smaller target - greater amount of energy is absorbed for the same force of impact Larger surface area:volume ratio - heat loss significant in children Relatively large head - easily injured Smaller mass - drug doses and fluid requirements differ
Features of the childs skeleton
Incompletely calcified - soft - springy - deforms rather than breaks - poor at absorbing energy Provides less protection for vital organs
Features of inside a childs body in respect to injury
Less elastic connective tissue
- shearing and degloving
Crowding of poorly protected vital organs
- liver, spleen, bladder are all intraabdomainl
Thermoregulation in children in injuries
Little brown fat and immature shivering
Pokilothermic
Environmental considerations e.g RTCs
Hypoglycaemia in children with injuries
Little glycogen stored in liver
Exacerbated by hypothermia and vice versa
Develops quickly in sick children
Injury patterns - SCIWORA
Spinal Cord Injury Without Radiological Abnormality
Why can communication difficulties be present in a child with an injury?
Too young or afraid to describe symptoms
Have to rely on non verbal cues
Good rapport essential
What does fear affect?
Vital signs
Long term effects of injury on children
Psychological recovery
Effects on normal growth and development
Respiratory failure features
Resp obstruction - birth asphyxia - croup - epiglottitis - foreign body inhalation - bronchiolitis - asthma - pneumothorax Resp depression - poisoning - convulsions - Raised ICP
Causes of Raised ICP
head injury
Acute encephalopathy
- meningitis / encephalitis
Life threatning traumas
Respiratory failure
Circulatory failure
Features of circulatory failure
Fluid loss - gastroenteritis - burns - trauma Fluid maldistribution - sepsis - anaphylaxis - heart failure
When is the first peak of deaths?
Die instantaneously
Die at the scene
Un survivable major vessel and brain injury
What is the only treatment?
Prevention
What is the second peak of deaths?
Die from significant ABCD problems unless adequately resuscitated
- platinum ten minutes
- golden hour
What is the aim of trauma resuscitation?
To restore normal tissue oxygenation as quickly as possible
What is done to treat trauma
cABCDE primary survery and resus 2ndry survery emergency treatment definitive care reassessment
Primary survey of cABCDE
catastrophic haemorrhage control Airway with C spine - remember O2 Breathing with ventilation Circulation with haemorrhage control Disability Exposure/Environment Dont ever forget glucose
Major risk factors for sudden infant death syndrome
Prone sleeping Parental smoking Bed sharing Hyperthermia and head covering Prematurity
What is the most significant factor in the cause of SIDS?
Co sleeping
The most common causes of arrest in children are what?
Respiratory
Protective factors of sudden infant death syndrome
Breastfeeding
Room sharing
Use of dummies
What is the triad for shaken baby syndrome?
Retinal haemorrhages
Subdural haematoma
Encephalopathy
Why at the start of paed CPR do you start with 5 rescue breaths?
A child is more likely to have collapsed due to respiratory causes
Where is the best places to check for a pulse in a child under 1 y/o?
Brachial
Femoral
Where is the best places to check for a pulse in a child > 1 y/o?
Femoral
Carotids
