The Injured Child

Question 1

What is the commonest cause of death from age 5 to 50?

Answer 1

Injury

Question 2

Which gender is more likely to die from injury?

Answer 2

3x more likely in boys

More likely to be blunt trauma as well

Question 3

What prevents death in injury?

Answer 3

Early intervention

Prevention better than cure

Question 4

Why do children sustain injuries?

Answer 4

Stage of development - anatomical, behavioural, locomotor, physiological, psychological
Their environment
Those around them

• written warnings, climbing, inquisitive nature, playing

Question 5

What is a toddler’s fracture?

Answer 5

Oblique tibial fracture in infants

Question 6

What is a greenstick’s fracture?

Answer 6

Unilateral cortical breach only

Occur when bone is pulled too far on one side of the bone

Question 7

Why do children get buckle/greenstick fractures more than adults?

Answer 7

Children’s bones are softer and more flexible

Question 8

What is the classification of growth plate injuries?

Answer 8

Salter Harris
1 - fracture through physis only
2 - fracture through physis and metaphysis
3 - fracture through physis and epiphysis to include the joint
4 - fracture involving physis, metaphysis and epiphysis
5 - crush injury involving physis

Question 9

Why are children more prone to hypothermia?

Answer 9

Large SA: vol ratio

Question 10

Why are children’s head easily injured?

Answer 10

They are relatively larger

Question 11

The skeleton of kids is incompletely calcified - what does this mean?

Answer 11

Skeleton is softer, more springy, deforms rather than breaking and is poor at absorbing energy

Also provides less protection for vital organs

Question 12

How are the internal organs different in a child?

Answer 12

Crowding of poorly protected vital organs

Liver, spleen, bladder are intra-abdominal

Question 13

How does the thermoregulation of a child differ to an adult?

Answer 13

Little brown fat and immature shivering
Pokilothermic
Environmental considerations e.g. RTCs

Question 14

Why are kids more at risk of hypoglycaemia?

Answer 14

Little glycogen stored in liver
Exacerbated by hypothermia and vice versa
Develops quickly in sick children

Question 15

What is sciwora?

Answer 15

Spinal cord injury without radiological abnormality

Question 16

What psychological factors may impact taking a history/examination from an injured child?

Answer 16

Too young/afraid to describe symptoms, have to rely on non-verbal cues
Fear affects vital signs
Distressed parents

Question 17

What are some examples of lifethreatening trauma?

Answer 17

Respiratory obstruction (e.g. FB inhalation, pneumothorax)
Respiratory depression (raised ICP e.g. due to head injury)
Fluid loss - e.g. burns, trauma

Question 18

What is the first peak of deaths?

Answer 18

Die instantly/at scene

Unsurvivable major vessel injury/brain trauma

Question 19

What are the second peak of deaths?

Answer 19

Die from significant ABCD problems unless adequately resuscitated (golden hour)

Question 20

What is done in ED for the injured child?

Answer 20

cABCDE
Primary survey and resus
Secondary survey 
Emergency treatment
Definitive care
Reassessment

Question 21

What is cABCDE?

Answer 21

catastrophic haemorrhage control
Airway with C-spine control - remember O2
Breathing with ventilation 
Circulation with haemorrhage control
Disability
Exposure/environment 
Don't Ever Forget Glucose

Question 22

How do you work out a child’s weight under 1y?

Answer 22

0.5 x age in months + 4

Question 23

How do you work out a child’s weight from 1-5y?

Answer 23

2 x age + 8

Question 24

How do you work out a child’s weight fro 6-10y?

Answer 24

3 x age + 7

Question 25

What is the third peak of deaths caused by?

Answer 25

Delayed deaths despite resus, surgery and ICU

Due to multi-organ failure, sepsis