Trauma Flashcards
Discuss your approach to a trauma injury in a child
CABC (remember they are injured so probably bleeding out)
Airway management
Check if breathing
Circulation - recognise and treat shock ie crystaloids
Check Hgt if altered LOC
Keep child warm
Run through immediately threatening issues
Outline the GCS for a child under 3 years
- MOTOR RESPONSE
Flexes and Extends 4
Withdraws from painful stimuli 3
Hypertonic 2
Flaccid 1 - VERBAL RESPONSE
Cries 3
Spontaneously breathing 2
No spontaneous breathing 1 - OCCULAR RESPONSE
Follows with eyes 4
Pupils react Doll’s eye reflex normal 3
Fixed pupils OR Doll’s eye reflex impaired 2
Fixed pupils AND Doll’s eye reflex impaired 1
What makes a paediatric airway difficult to manage during intubation and what is the complications of this
- Increased vagal response to laryngoscopy- Brady during intubation
- Large tongue- airway obstruction
- Floppy U shape Epiglottis - necessitates straight blade
- Large floppy head- Positioning difficult
- Large adenoidal- difficult nasotracheal intubation and nasopharyngeal intubation
- Anterior cephalic larync- Difficult visualising cords
Cricoid=narrowest portion- difficulty passing ET tube - Short trachea length- Can lead to R mainstem intubation
- LArge airway more narrow - greater airway resistance
how to minimise effects of difficult airways in paeds to ensure successsful airway management
Patency- Use oral to prevent osbtruction by tongue, suction blood or secretions, foreign bodies
Position- Towel under torso
Protection- cuffed ETT (age/4+3.5) in all trauma pt
What would you give to a child incase of bradycardic response to intubation
Atropine 0.02 mg/kg (0.1mg - 0.5mg)
What would you give in head injured patients to blunt the rise in ICP secondary to intubation
Fentanyl 2-5 mcg/kg 3-5 min prior to intubation
What are the common manifestations of a shocked paediatric patient
Tachycardia
Narrow pulse pressure
Delayed capillary refill time
cool extremities
Altered mental status.
mottling skin
When does decompensated shock occur in a paediatric trauma patient
Blood pressure is maintained until 30-40% blood loss due
to great cardiac reserve, afterwhich hypotension occurs as sign of decompensated shock
what is the maximum flow rate of IV rescuscitation in paediatrics
25 ml/min
How much crystalloid do you give before you can give blood
10-40 ml/kg of warmed crystalloid prior to blood is reasonable in pediatric polytrauma patients in compensated shock
Blood is essential for decompensated shock
What constitues to severe head trauma in paeds
GCS <8
Pt is only responsive to pain
Worse on AVPU
(any of these)
Whhat are some potential complications of severe head injury
raised ICP
poor perfussion
secondary brain injury
What are the 5 parameters that must be aggresively avoided in paediatric patient with severe head injury
- Hypotension – maintain normal SBP and euvolemia
- Hypoxia – maintain SaO2 > 90% and PaCO2 35-40mmHg
- Hypothermia – warmed crystalloid and blood, warmed room, overhead warmer or Bair hugger
- Hypoglycemia – the DEFG in ABCDEFG stands for “Don’t Ever Forget the Glucose”
- Raised ICP – keep head of bed at 30 degrees, remove collar, pain and anxiety control, treat seizures
aggressively, normocapnea
What do you do for a patient showing signs of herniation
- Hyperventilate to a target pupillary response of constriction and
- Administer 3% hypertonic saline 3-4 ml/kg boluses followed by an infusion until the patient reacher OR
Where do most c spine injuries occur
between c1-c3
