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TAS Accidents and Poisoning ✅ > Trauma ✅ > Flashcards

Trauma ✅ Flashcards

1
Q

What is the most common cause of death in injured children?

A

Head injury

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2
Q

What is the principal determinant of outcome in multisystem trauma?

A

Severity of any head injury

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3
Q

What is the most common cause of severe head injury in young children?

A

Falls

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4
Q

What is the most common cause of severe head injury in older children?

A

Road traffic collisions, particularly from cycling accidents

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5
Q

What should be considered in all infants presenting with a head injury?

A

NAI

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6
Q

What can damage to the CNS caused by head injury be divided into?

A
  • Primary

- Secondary

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7
Q

What is a primary head injury?

A

An injured sustained as a direct consequence of the impact, causing disruption of the intracranial contents

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8
Q

Give 2 types of primary head injury

A
  • Diffuse axonal injury

- Vascular trauma

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9
Q

Why is diffuse axonal injury an important condition?

A

it is one of the most serious forms of primary neuronal injury, and is associated with high mortality and neurodisability

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10
Q

Why is DAI such a serious condition?

A

Because it results in widespread injury in the brain, not just in one specific area

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11
Q

What causes DAI?

A

Traumatic shearing forces due to rapid acceleration, deceleration, and/or rotation of the brain

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12
Q

What happens as the brain moves rapidly backwards and forwards in the skull?

A

The axons are disrupted, particularly at the grey-white matter junction

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13
Q

What do the clinical manifestations of DAI depend on?

A

The site and severity of axonal damage

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14
Q

What is a predominant feature of DAI?

A

Loss of consciousness

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15
Q

What imaging is useful in DAI?

A

MRI (not seen on CT)

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16
Q

How can trauma lead to vascular injury?

A

The force of impact may cause injury to intracranial blood vessels, leading to bleeding within the skull

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17
Q

What is an extra-axial bleed?

A

One occurring outside the brain

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18
Q

Of what type are most traumatic extra-axial bleeds?

A
  • Extradural

- Subdural

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19
Q

Where does blood accumulate in extradural haematomas?

A

Between dura mater and skull

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20
Q

Are extradural haematomas usually arterial or venous?

A

Arterial

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21
Q

Which vessel in particular commonly causes extradural haematomas?

A

Middle meningeal artery

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22
Q

What is the result of extradural haematomas commonly being arterial bleeds?

A

They develop rapidly

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23
Q

Where is the bleeding in subdural haematomas?

A

Between the dura mater and arachnoid mater

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24
Q

Are subdural haematomas usually arterial of venous?

A

Venous

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25
Q

What is the result of subdural haematomas usually being venous?

A

They develop more slowly

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26
Q

What is the most common source of bleeding in subdural haematomas?

A

Bridging veins in the dural region

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27
Q

What can subdural and extradural haematoma lead to?

A

Raised ICP as the brain enlarges

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28
Q

What can the raised ICP in subdural and extradural haematoma lead to?

A

Mass effect and compression of brain tissue

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29
Q

What kind of haematoma is seen in non-accidental head injury?

A

Subural

30
Q

When should suspicion be raised that a subdural haematoma is caused by non-accidental injury?

A

Incidental finding, or finding inconsistent with history given

31
Q

Can traumatic subarachnoid haemorrhages occur in children?

A

Yes

32
Q

What do traumatic subarachnoid haemorrhages often develop in close proximity to?

A

Cerebral contusions or skull fractures

33
Q

What is a secondary head injury?

A

Further damage to the brain that can occur minutes to days after the original injury

34
Q

Why is it important to recognise secondary head injury?

A

They are often either preventable or treatable, and failure to minimise its effects results in a poorer outcome

35
Q

What is required to prevent/recognise secondary head injury?

A

Patients with significant traumatic brain injury need extremely close monitoring, especially in initial period after the injury

36
Q

What is the aim of close monitoring following significant traumatic brain injury?

A

Prevention and treatment of complications which may give rise to secondary injury

37
Q

What is true of the vast majority of paediatric head injuries?

A

They are mild

38
Q

How is it decided if a child with a head injury requires neuroimaging?

A

Various criteria, related to both the history and examination, are used to try and predict the likelihood of intracranial pathology

39
Q

Which factors, when present alone, indicate the need for CT scan following traumatic head injury?

A
  • Suspicion of NAI
  • Post-traumatic seizure
  • GCS <14 on arrival at ED, or <15 if under 1 year old
  • Suspected open or depressed skull fracture
  • Evidence of basal skull fracture
  • Focal neurological deficit
  • Presence of bruise or swelling >5cm in diameter in children aged <1 year
40
Q

Which factors, when 2+ present, indicate the need for CT scan following traumatic head injury?

A
  • Witnessed LoC >5 mins
  • Abnormal drowsiness
  • > 2 discrete episodes of vomiting
  • Amnesia >5 mins
  • Dangerous mechanism of injury
41
Q

What are the advantages of using the NICE criteria for CT scan following traumatic head injury?

A

They have excellent sensitivity

42
Q

What are the disadvantages of using the NICE criteria for CT head following traumatic head injury?

A

They have poor specificity and results in a significant number of normal scans

43
Q

What is the aim of resuscitation in a child with severe head injury?

A

Maximise cerebral perfusion whilst minimising the effect of raised ICP

44
Q

What is the outcome of a severe traumatic brain injury?

A

Likely to have a very long period of recovery, with intensive rehabilitation therapy, but likely to recover some function

45
Q

What are the most common long-term sequelae of severe traumatic head injuries?

A

Cognitive, behavioural, and psychiatric problems

46
Q

What can cognitive problems following traumatic brain injury lead ti?

A

Difficulty with memory, learning, and language

47
Q

What behavioural and psychiatric problems may result from a traumatic brain injury?

A
  • Personality changes
  • Lack of inhibition
  • Depression
48
Q

What do the outcomes of severe traumatic brain injury vary depending on?

A
  • Severity of injury
  • Age of child
  • Pre-morbid condition
49
Q

What is the most common cause of spinal cord injury in children?

A

Road traffic collisions

50
Q

What does the most common cervical fracture involve?

A

The first 2 vertebrae

51
Q

What kind of spinal cord injury is almost exclusively a paediatric problem?

A

Spinal cord injury without radiologic abnormality (SCIWORA)

52
Q

What does SCIWORA result from?

A

The elasticity of the cervical spine allowing significant cord injury in the absence of x-ray changes

53
Q

What are the most common causes of thoracic injury in children?

A
  • Road traffic accidents

- Falls

54
Q

Are chest injuries more commonly caused by penetrating trauma or blunt trauma?

A

Blunt trauma

55
Q

What do chest injuries usually occur in conjunction with?

A

Trauma to other body parts

56
Q

How does the chest wall of children compare to adults?

A

It is much more complaint

57
Q

What is the result of the chest wall of children being much more compliant than that of adults?

A

It leads to transfer of impact energy to underlying organs and structures with minimal, if any, external sign of injury or fracture

58
Q

What does the presence of rib fractures or mediastinal injury indicate?

A

A very significant and high energy impact

59
Q

What are the common thoracic injuries in children?

A
  • Lung contusions

- Pneumothoraces

60
Q

What causes lung contusions?

A

Energy being transferred rapidly into the lungs, causing haemorrhage and oedema in the lung tissue

61
Q

How common is great vessel trauma in thoracic injury?

A

Very rare

62
Q

Why are children more vulnerable to major abdominal injuries?

A
  • Pliable rib cages, which provide little protection to solid organs
  • Solid organs proportionally larger than in adults
  • Abdominal wall thin and provides less impact absorption
63
Q

Are abdominal injuries more commonly caused by blunt or penetrating trauma?

A

Blunt

64
Q

What are the most common causes of abdominal injuries?

A
  • Road traffic collisions
  • Set belt restraint
  • Handlebar injury
65
Q

What is the result of intra-abdominal organs bleeding readily?

A

Can result in hypovolaemia and circulatory collapse

66
Q

What can acceleration and deceleration forces cause?

A

Injury to organs, which are moved rapidly and may come into contact with the spine

67
Q

Why are abdominal injuries dangerous?

A

They can be life-threatening and difficult to diagnose quickly in the absence of external signs

68
Q

What abdominal organ injuries manifest rapidly?

A
  • Spleen

- Liver

69
Q

What abdominal organ injuries don’t become clinically evident for several days?

A
  • Bowel

- Pancreatic

70
Q

What is required as a result of the difficulty in diagnosing abdominal injuries?

A

An active approach to identifying abdominal injury, especially in high mechanism injuries

71
Q

What is a useful tool in detecting abdominal injuries?

A

Focused abdominal sonography for trauma (FAST)

72
Q

What is the limitation of FAST scanning?

A
  • Can miss major solid organ injury

- Must be combined with clinical judgement

TAS Accidents and Poisoning ✅ (12 decks)

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