The Injured Child Flashcards
what is the problem with injuries?
Commonest cause of death from age 5 to 50s
Boys 3x more likely to die from injury than girls
Blunt trauma >>> Penetrating trauma
Often causes multisystem injury
Early intervention prevents death
Prevention is ALWAYS better than cure
Why do children sustain injuries?
Interaction between
- Stage of development - Anatomical, behavioural, locomotor, physiological, psychological
- Their environment
- Those around them
Think about - Audio-visual cues, written warnings, climbing, inquisitive nature, playing, risky behaviour
What injuries do children sustain?
Fracture - Buckle fracture of distal radius, Clavicle fracture, Toddler’s fracture of tibia, Greenstick, fracture, Growth plate injuries
Wounds - History and mechanism of injury is very important
Burns & Scalds
Head Injury
Drowning
Why do children injure differently?
Children are not little adults:
- Different anatomical features
- Different physiological & psychological responses to injury
- Different spectrum of injury patterns
Not all children are the same - Neonates, infants, toddlers, children, adolescents
how does the size of child affect injury?
Smaller target - Relatively greater amount of energy is absorbed for the same force of impact
Large surface area:volume ratio - Heat loss significant in small children
Relatively large head - Easily injured
Smaller mass - Drug doses and fluid requirements differ, Different equipment and techniques
how does a childs skeleton affect injury?
Incompletely calcified - Soft, Springy, Deforms rather than breaks, Poor at absorbing energy
Provides less protection for vital organs
how does hypoglycaemia occur in children?
Little glycogen stored in liver
Exacerbated by hypothermia and vice versa
Develops quickly in sick children
Low muscle stores so low glycogen stores so hypoglycaemia kicks in quicker
mechanism of injury - how do you gain information about this?
Take a good history
“Read the wreckage”
Do the injuries fit with the story? Non-Accidental Injury
how do children repsond to injuries psychologically?
Communication difficulties - Too young or afraid to describe symptoms, Have to rely on non-verbal cues, Good rapport essential
Fear affects vital signs
Distressed parents
Effects on staff
how can an onjury affect a child long term?
Psychological recovery from trauma
Effects on normal growth and development
what is the normal HR, BP and RR of a child?
Keep in mind that the numbers change with age
Know the trends
Life-threatening trauma - what causes respiratory failure?
Respiratory Obstruction - Birth asphyxia, Croup, Epiglottitis, Foreign body inhalation, Bronchiolitis, Asthma, Pneumothorax
Respiratory Depression - Poisoning, Convulsions, Raised intra-cranial pressure (head injury)
Life-threatening trauma - what causes circulatory failure?
Fluid Loss - Gastroenteritis, Burns, Trauma
Fluid Maldistribution - Sepsis, Anaphylaxis, Heart failure
What is the aim of trauma resuscitation?
To restore normal tissue oxygenation as quickly as possible
What do we do in the ED?
cABCDE
1º Survey + Resuscitation
2º Survey
Emergency Treatment
Definitive Care
Reassessment
Children are not small adults! - how can you calculate a childs weight?
