Trauma

Question 1

Name indications for an abdominal CT scan in pediatric trauma (5)

Answer 1

• physical signs of abdominal trauma
• hematuria
• significant mechanism of injury with depressed mental status
• slowly declining hematocrit
• unaccountable fluid or blood requirements
• acute ‘need to know’ before GA

Question 2

After what % of blood loss do you start to see changes in systolic blood pressure?

Answer 2

> /=40%

Fleisher

Question 3

What is the basic trauma work-up?

Answer 3

CBC count
amylase/lipase
liver function tests
gas + lactate
urinalysis
radiographs of the chest, cervical spine, and/or pelvis.
A type and cross for red blood cells is indicated if ongoing hemorrhage is suspected or the need for operative intervention is anticipated

Question 4

What are features of neurogenic shock?

How to manage it?

Answer 4

Hypotension without increased HR or vasocontriction, seen in high cervical/ thoracic spine injury

1st: fill up the tank with fluids
2nd: norepinephrine infusion, phenylephrine in adults

Question 5

What is spinal shock?

Answer 5

neugogenic dysfunction without autonomic dysfunction

due to a concussed spinal cord, it is reversible

Question 6

What is seatbelt syndrome?

Answer 6

Instead of a seatbelt securing the pelvis, it wraps and squeezes the abdomen in little kids:

1) bowel wall ecchymosis
2) intraabdominal organ injuries
3) vertebral fractures, possible spinal cord and aortic fractures

fixed organs are at the highest risk ie: duodenum

Question 7

What are the target urine outputs in children?

Answer 7

In <1 year: 2mL/kg/hr

In >1 year: 1mL/kg/hr

Question 8

How can you clear a cervical spine in a child?
If they are:
Alert and cooperative
High risk mechanism +/- helmet
Altered sensorium
Coma

Answer 8

Alert cooperative kids with low risk: adult NEXUS
High risk mechanism or pain: cervical spine x-rays, if helmeted and no need to manage airways perform WITH helmet on
If altered sensorium: leave the collar on
Prolonged coma: xrays, MRI spine, brain evoked potentials

Question 9

What are the NEXUS criteria?

Answer 9

1. No midline tenderness.
2. No focal neurologic deficits.
3. Normal alertness.
4. No intoxication.
5. No painful distracting injury.

Question 10

What performs better in adults, NEXUS or Canadian C-spine Rules?

Answer 10

CCR!

Question 11

What are CCR strict exclusion factors?

Low risk inclusion factors?

Answer 11

EXCLUSION:
>65
paresthesias in the extremities
high risk mechanism (fall >3feet/5stairs, axial load to head, MVC >100km/hr/rollover/ejection, ATV or motorcycle, bicycle struck or collision)

INCLUSION (any of the following) to rotate and examine:
absence of midline spinal tenderness
sitting position in the ED
ambulatory at any time
delayed onset neck pain
simple rear-end MVC (excludes being pushed into oncoming traffic, hit by bus or large truck, rollover, hit by high speed vehicle)

Question 12

What’s the best transfusion ratio?

Answer 12

1:1:1

RBCs, platelets, FFPs

Question 13

What are the most appropriate treatments for spinal shock?

Answer 13

• IVF

- norepinephrine (alpha and beta adrenergic activity)

Question 14

What is the antidote for bleeding in VWD and Hemophilia A?

Answer 14

Desmopressin

stimulated VWF and Factor VIII from endothelial cells

Question 15

What is the antidote for warfarin coagulopathy?

Answer 15

vitamin K

Factors 2, 7, 9, 10

Question 16

What does cryoprecipitate contain?

Answer 16

Factors 8, 9, VWF and fibrinogen

Question 17

What levels of AST and ALT are suggestive of intra-abdominal injuries?

Answer 17

AST 200

ALT 125