Trauma

Question 1

Anterior spinal cord syndrome

Answer 1

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

Question 2

Central spinal cord syndrome

Answer 2

injury to the central cord only.

• upper extremity motor and sensory deficits GREATER than lower ( can kick feet but not move arms)
• Improved prognosis

Question 3

Brown Sequard syndrome

Answer 3

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)

Question 4

How do you clear a c spine in a child

Answer 4

Need to see ALL 7 cervical vertebra, full assessment and CT.. cleared by neurosurg usually ( know your credentials)

Question 5

What are the sx of neurogenic shock/spinal shock

Answer 5

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)

Question 6

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

Answer 6

Orbital entrapment= EMERGENCY

Question 7

what is the most common thoracic injury in children

Answer 7

pulmonary contusion

Question 8

what is the MGMT for pulmonary contusion

Answer 8

Fluid restriction, 02, pulmonary toilet, protective lung strategies. 50% have associated injuries
- DRY lung is happy lung

Question 9

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

Answer 9

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

Question 10

Rib fracture– are they common in children

Answer 10

No- likely NAT: require significant energy transfer

Question 11

what is the most frequently injury organ

Answer 11

spleen ( but liver has higher mortality)

Question 12

Susie is aspelnic follow a splenic lac. What is the # 1 causative agent of an infection

Answer 12

Streptococcus pneumococcus and encapsulated organisms

Question 13

Referred left shoulder pain associated with a splenic lac is called

Answer 13

Kehrs sign

Question 14

AST/ ALT in liver injru

Answer 14

AST 25.. Hg/hct
Hgb: 12-17
Hct: 36-46%

Question 15

Your patient has a suspected spleen lac- what imaging do you order

Answer 15

CT with IV contrast ( or oral, IV better)

Question 16

What is the nonoperativ mgmt. for a liver lac

Answer 16

Grade + 1 day in hospital
Grade 3= ICU - hospital specific
*serial h/h and close observation *

Question 17

what is the circulating blood volume in children

Answer 17

70-80 ml.kg - higher in infants

Question 18

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

Answer 18

REMOVE the cast

Question 19

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

Answer 19

Nurse Maid reduction- PRONATE, SUPINATE then FLEX

The technical term for the injury is radial head subluxation.

Question 20

IF you patient has an abrupt drop in HGB what do you expect and where do you look

Answer 20

Bleeding! ABD, pelvis, head and long bones

Question 21

the 3 Ps of compartment syndrome

Answer 21

pallor, pulseless, and paralysis

Question 22

the 3 A

Answer 22

anxiety, analgesic requirement and agitation

Question 23

Following falling off a dirt bike, Eric is complaining of RUQ pain and pain in the Right shoulder.. What do you suspect

Answer 23

Liver Lac

Question 24

What is the MGMT for eric’s condition

Answer 24

H+H q 4-6 hrs

Question 25

Using the parkland formula:

a 10 kg pt has 20% total BSA burns. How much fluid do you give

Answer 25

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

Question 26

Based on Salter Harris -what kind of fx is most common : separation of the plate with a fracture

Answer 26

II= MGMT: closed reduction and cast

Question 27

A burn child is complaining of pain.. what medications should you avoid

Answer 27

Fentanyl and Benzos== can potentiate delirium

Question 28

What are the rule of 9’s

Answer 28

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

Question 29

Anna has a partial thickness burn on her left arm. She is 10 years old with no allergies- what is the treatment

Answer 29

Silvadene ointment., IVF, pain control

Avoid Silvadene is young infants and Sulfa sensitive children

Question 30

What stage of a burn has a blister

Answer 30

Partial thickness

superficial, partial thickness, full thickness, deep full thickness

Question 31

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

Answer 31

SCIFE

Question 32

How do you dx a SCIFE

Answer 32

Plain xray, may need CT or MRI, surgical pinning required

Question 33

What is leg calve perthes disease

Answer 33

Avascular necrosis of the femoral head over a length of time: Sx include:

AP and frog leg films

Question 34

What e lyte should we leave out in a child with burns

Answer 34

leave out K because K is released from dying burned cells

Question 35

What is the treatment for a child with suspected CO inhalation

Answer 35

100 % humidified air 02 via non rebreather

Question 36

Classic signs include a sudden exacerbation with high, thigh, or knee pain, limited internal rotation and obligated external rotation

Answer 36

SCFE

Question 37

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

Answer 37

Staph

Question 38

1 year old with as splenic lac is going to the OR and is losing spleen.. what would we want to consider

Answer 38

Vaccinate againt HIB, Nisseria Mening, Post op= PCN prophylaxis for pneumococcus