The Injured Child

Question 1

Trauma - epidemiology

Answer 1

• Commonest cause of death from 5 to 50 years old
• B>G
• Blunt trauma > penetrating trauma

Question 2

What are some common traumas in children?

Answer 2

• Fractures
  
  • Buckle fracture of distal radius
  • Clavicle fracture
  • Toddler’s fracture of tibia
  • Greenstick fracture
  • Growth plate injuries
• Wounds
  
  • Scissors
• Burns and scalds
• Head injury
• Drowning

Question 3

What are common fractures in children?

Answer 3

• Buckle fracture of distal radius
• Clavicle fracture
• Toddler’s fracture of tibia
• Greenstick fracture
• Growth plate injuries

Question 4

What are some reasons children injure differently?

Answer 4

• Smaller target so greater energy is absorbed for same force of impact
• Large head that is easily injured
• Large surface area to volume ratio so heat loss significant in small children
• Skeleton is incompletely calfified
• Less elastic connective tissue
• Prone to hypothermia and hypoglycaemia

Question 5

Why is mechanism of injury important?

Answer 5

Always consider non-accidental injury:

• Do the injuries fit with the story
  
  • Fractures of long bones usually non-accidental

Question 6

What are some injury patterns?

Answer 6

• SCIWORA (spinal cord injury without radiological abnormality)
• Lap belt syndrome

Question 7

What are some psychological factors for trauma in children?

Answer 7

• Communication difficulties
• Fear affects vital signs
• Distressed parents
• Effects on staff

Question 8

What are some long term effects for trauma in children?

Answer 8

• Psychological impact
• Impact on growth and development

Question 9

For <1 year:

• RR
• SBP
• HR

Answer 9

Question 10

For 2-5 years:

• RR
• SBP
• HR

Answer 10

Question 11

For 5-12 years:

• RR
• SBP
• HR

Answer 11

Question 12

For >12 years:

• RR
• SBP
• HR

Answer 12

Question 13

What are complications of trauma that can make if life threatening?

Answer 13

• Respiratory failure
  
  • Respiratory obstruction
    
    • Foreign body inhalation
    • Pneumothorax
  • Respiratory depression
    
    • Raised ICP
• Circulatory failure
  
  • Fluid loss
    
    • Burns
    • Trauma
  • Fluid maldistribution
    
    • Sepsis

Question 14

What is a formula to calculate the weight of children who are:

• birth weight
• <1 year
• 1 to 5 years
• 6 to 10 years

Answer 14

Question 15

Trauma - treatment

Answer 15

Treatment is ABCD approach, prevention of un-survivable major vessel and brain injuries:

• Restore normal tissue oxygenation as soon as possible

Question 16

Describe the primary cABCDE survey?

Answer 16

• Catastrophic haemorrhage control
• Airway with C-spine
• Breathing with ventilation
• Circulation with haemorrhage control
• Disability
• Exposure/environment
• Glucose!

Question 17

Describe the universal approach for trauma treatment?

Answer 17

• cABCDE
  
  • 1^st survey and resuscitation
  • 2^nd survey
  • Emergency treatment
  • Definitive care
  • Reassessment