Trauma Flashcards
Anterior spinal cord syndrome
injury to anterior 2/3 of spinal cord.
often associated with injury to the anterior spinal artery.
* loss of sensory and motor function BELOW the lesion.
* preservation of deep sensation = poor prognosis
Central spinal cord syndrome
injury to the central cord only.
- upper extremity motor and sensory deficits GREATER than lower ( can kick feet but not move arms)
- Improved prognosis
Brown Sequard syndrome
injury to a HEMISECTION of the cord.
* ipsilateral loss of motor function
* contralateral loss of PAIN and Temp.
Improved prognosis
( L side injury= cant move L side, R side can move)
( R side- cant feel pain and temp, but L can)
How do you clear a c spine in a child
Need to see ALL 7 cervical vertebra, full assessment and CT.. cleared by neurosurg usually ( know your credentials)
What are the sx of neurogenic shock/spinal shock
Loss of sympathetic innervation with parasympathetic predominance
- unopposed vagal nerve- bradycardia
- Loss of vasomotor tone, passive vasodilation, decreased venous return, decreased CO
MGMT: volume resuscitation and vasopressor support ( norepi- increased alpha tone)
Johnny was just in a MVC and on your exam, he is unable to move his right eye up and down. What is the dx and mgmt
Orbital entrapment= EMERGENCY
what is the most common thoracic injury in children
pulmonary contusion
what is the MGMT for pulmonary contusion
Fluid restriction, 02, pulmonary toilet, protective lung strategies. 50% have associated injuries
- DRY lung is happy lung
While reviewing a CXR of a 12 year old female follow a MVC, you notice a widened mediastiumun , 1st and 2nd rib fracture, and an obscured aortic know with a BP differential .. she has ..how do you MGMT
Aortic injury: 50 % have no external evidence
DX: on CXR/ CT/CTA/ echo or an arch angiography
MGMT: BB and control HR and decreased MAP
Often delay surgery until stable– stent vs bypass
Rib fracture– are they common in children
No- likely NAT: require significant energy transfer
what is the most frequently injury organ
spleen ( but liver has higher mortality)
Susie is aspelnic follow a splenic lac. What is the # 1 causative agent of an infection
Streptococcus pneumococcus and encapsulated organisms
Referred left shoulder pain associated with a splenic lac is called
Kehrs sign
AST/ ALT in liver injru
AST 25.. Hg/hct
Hgb: 12-17
Hct: 36-46%
Your patient has a suspected spleen lac- what imaging do you order
CT with IV contrast ( or oral, IV better)
What is the nonoperativ mgmt. for a liver lac
Grade + 1 day in hospital
Grade 3= ICU - hospital specific
*serial h/h and close observation *
what is the circulating blood volume in children
70-80 ml.kg - higher in infants
Timmy is complaining of severe left foot pain after getting hid cast placed on last week. You palpate his feet which are cold with poor perfusion and cap refill. The MOST impt intervention is to
REMOVE the cast
3 year old Sally walking across the street with mom, is now complaining of arm pain. Sally is complaining of pain, arm is hanging down and she is not using it. What should you do
Nurse Maid reduction- PRONATE, SUPINATE then FLEX
The technical term for the injury is radial head subluxation.
IF you patient has an abrupt drop in HGB what do you expect and where do you look
Bleeding! ABD, pelvis, head and long bones
the 3 Ps of compartment syndrome
pallor, pulseless, and paralysis
the 3 A
anxiety, analgesic requirement and agitation
Following falling off a dirt bike, Eric is complaining of RUQ pain and pain in the Right shoulder.. What do you suspect
Liver Lac
What is the MGMT for eric’s condition
H+H q 4-6 hrs
Using the parkland formula:
a 10 kg pt has 20% total BSA burns. How much fluid do you give
Parkland: 4 ml/kg per day PER percentage BSA ( of burn)
Give HALF over the first 8 hours, and the remaining hold over the next 16 hours. Make sure your UO is 1-2 ml/kg/hr: Withhold K- Use LR or NS
ex: 4 ( 10 kg) ( 20)= 800 in 24 hours
Give 400 over 8 hours= 50 ml/hr
Give the remaining 400 over the next 16 hours= 25 ml/hr
Based on Salter Harris -what kind of fx is most common : separation of the plate with a fracture
II= MGMT: closed reduction and cast
A burn child is complaining of pain.. what medications should you avoid
Fentanyl and Benzos== can potentiate delirium
What are the rule of 9’s
Head: 18%, Arm= 9%, Abd: 18%, BackL 18%, Leg 14%, and genitals is 1 %.
( 1 child hand= 1%)
Refer to burn center: > 10% BSA, Admit if 30= consider intubation
Anna has a partial thickness burn on her left arm. She is 10 years old with no allergies- what is the treatment
Silvadene ointment., IVF, pain control
Avoid Silvadene is young infants and Sulfa sensitive children
What stage of a burn has a blister
Partial thickness
superficial, partial thickness, full thickness, deep full thickness
a 14 year old obese child comes to the ED with sudden hip pain and is not able to walk. What are you concerned for
SCIFE
How do you dx a SCIFE
Plain xray, may need CT or MRI, surgical pinning required
What is leg calve perthes disease
Avascular necrosis of the femoral head over a length of time: Sx include:
AP and frog leg films
What e lyte should we leave out in a child with burns
leave out K because K is released from dying burned cells
What is the treatment for a child with suspected CO inhalation
100 % humidified air 02 via non rebreather
Classic signs include a sudden exacerbation with high, thigh, or knee pain, limited internal rotation and obligated external rotation
SCFE
Katy recently fell off her bike and had an open wound. 4 days later she is complaining of pain over her ankle, has a low grade fever.. what organism are you concerned of
Staph
1 year old with as splenic lac is going to the OR and is losing spleen.. what would we want to consider
Vaccinate againt HIB, Nisseria Mening, Post op= PCN prophylaxis for pneumococcus
