The Injured Child

Question 1

Common fractures in children?

Answer 1

Buckle fracture of distal radius,
Clavicle fracture,
Toddler’s fracture of tibia,
Greenstick fracture,
Growth plate injuries (Salter Harris Classification)

Question 2

Main injuries children sustain and present in A&E with

Answer 2

Fracture, 
Wounds,
Burns and scalds,
Head injury,
Drowning

Question 3

Why do children injure differently to adults?

Answer 3

Size:

• Smaller target (greater amount of energy absorbed for same force of impacy)
• Large surface area:volume ratio (heat loss significant)
• Relatively large head (easily injured)
• Smaller mass (affects drug dose)

Skeleton:

• Incompletely calcified (soft, springy, deforms rather than breaks, poor at absorbing energy)
• Less protection for vital organs

Inside:

• Less elastic connective tissue
• Crowding of poorly protected vital organs

Metabolism:

• Immature shivering
• Pokilothermic
• Hypoglycaema (increase risk and little glycogen stored in liver)(exacerbated in hypothermia)

Question 4

What to worry for injury pattern in children

Answer 4

SCIWORA- Spinal Cord Injury Without Radiological Abnormality
(Can have flexion and extension injuries without fracture)

Lap Belt syndrome (damage to head, chest as well as laceration of stomach and bowel)

Waddell’s triad:
Pedestrian children who are struck by motor vehicles
Fractured femoral shaft,
Intra-thoracic or intra-abdominal injuries, Contralateral head injury

Question 5

Psychological differences in paediatrics injury

Answer 5

Communication difficulties:
-cant describe
Fear affects vital signs

Question 6

Long term effects of injured child

Answer 6

Psychological recovery from trauma

Effects on normal growth and development

Question 7

Respiratory obstructions that are life threatening

Answer 7

Birht asphyxia, 
Croup,
Epiglottitis,
Foreign body inhalation, 
Bronchiolitis
Asthma
Pneumothorax

Question 8

Respiratory depression causes that are life threatening

Answer 8

Poisoning
Convulsions
Raised ICP:
-head injury
-acute encephalopathy- meningitis, encephalitis

Question 9

Cirulatory failure causes that are life threatening

Answer 9

Fluid loss:
-gastroenteritis
-burns
-trauma
Fluid Maldistribution:
-Sepsis
-Anaphylaxis
-Heart failure

Question 10

Causes of first peak, second, third peak of deaths

Answer 10

First peak- die instantaneously, unsurvivable major vessel and brain injury

Second peak- ABCD problems “golden hour” we can help improve these outcomes

Third peak- delayed deaths, multiorgan failure, sepsis (R&R, 3rd world)

Question 11

What is the aim of trauma resuscitation

Answer 11

To restore normal tissue oxygenation as quickly as possible