The injured child

Question 1

where is a buckle fracture?

Answer 1

fracture at the distal radius

Question 2

how does a toddlers fracture of the tibia occur?

Answer 2

toddlers don’t twist their ankles, the force is transmitted up their tibia

Question 3

how does a greenstick fracture of the forearm present?

Answer 3

z shape deformity

Question 4

how does a clavicle fracture occur?

Answer 4

landing on an outstretched arm

the force is transmitted up the arm to the clavicle

Question 5

what grading system is used to grade growth plate fractureS?

Answer 5

salter harris

Question 6

what are the life threatening injuries you have to be aware of in a child who presents from a trauma?

Answer 6

rep failure;
- foreign body
- pneumothorax
increased ICP - head injury 
fluid loss due to burns
fluid redistribution due to sepsis

Question 7

what pattern of injury is SCIWORA?

Answer 7

spinal cord injury without radiological abnormality

Question 8

what pattern of injury would you expect from a lap belt syndrome from an RTA?

Answer 8

lunar vertebral fracture
small bowel mesentery injury
seat belt mark

Question 9

what pattern of injury is waddles triad and from what mechanism of injury is it found?

Answer 9

hit by a car

intra-abdominal/ intra-thoracic injury
contralateral head injury
femoral shaft fracture

Question 10

what is involved in the primary surgery?

Answer 10

c- catastrophic haemorrhage 
Airways (give 02)
Breathing (may require ventilation)
Circulation (haemorrhage protocol)
Disability 
Exposure / environment (hypothermia in children)
DEFG - don't ever forget glucose!!

Question 11

what is involved in the trauma resuscitation of a patient?

Answer 11

primary surgery - cABCDE
secondary surgery 
emergency treatment 
definitive care
reassessment

Question 12

what are the 1st, 2nd and 3rd peaks of death involving a trauma?

Answer 12

1st peak of death are those who die at the scene or before they get care at hospital
2nd peak of death are those who die due to significant ABCDE problems
3rd peak of death are delayed deaths who die despite surgery and intensive care

Question 13

why do children fracture differently to adults?

Answer 13

incompletely ossified 
high metabolic periosteum 
heal quicker 
deform rather than break = plastic deformations
poor at absorbing energy

Question 14

what is the difference in children metabolism compared to an adults and why is this of clinical significance during trauma?

Answer 14

little brown fat + poor shivering mechanism make them susceptible to hypothermia
hypoglycaemia develops quickly in children due to poor glycogen stores
hypoglycaemia is exacerbated by hypothermia