Trauma & first aid

Question 1

What are the differences in ABCD approach for trauma/resus in children?

Answer 1

Airways - as per adults

• If crying patent airway
• Insert gadels with direct vision (no turning)
• Same airway maneouvres

Breathing

• O2 if sats <95-92%
• If circumferential chest burn consider axial line escharotomy (cut through burns as burn tissue is restrictive to breathing)

Circulation

• Maintenance rule - 4/2/1 for 1st, 2nd 10kg and rest of weight
• If burns consider increased fluid needs and poor glycogen storage - need maintance with dextrose to avoid hypoglycaemia

Disability

• Use AVPU (alert, response to voice or pain and unresponsive) in stead of GCS
• Cervical collar <2 not effective, need manual stabilisation
• Pupils

Question 2

What are key considerations & Rx in trauma from burns?

Answer 2

Circumferential chest burns can restrict breathing

Circumferential lower limb burns can act as torniquet - consider escharotomy or elevation of limbs

Wound care - assess TBSA affected and deepth/circumference burns

Consider hypoglycaemia, hypovolaemia and hypothermia

• Dextrose maintenance fluids
• Plastic wrap over wounds to retain heat and moisture
• Warm the evironment and patient with bear huggers etc

Pain assessment and management

Question 3

What are key considerations & Rx in abdominal trauma?

Answer 3

Children more suscepetible to abdo trauma - smaller torso, less protective habitus and compliant ribs

Consider pelvic CT/XR if abdo tenderness, high riding selt belt bruising

Need to insert urinary catheter and gastric decompresion tube (prevent acute gastric dilation, vomiting and aspiration and improves imaging quality)

Question 4

What is the first aid Rx for burns?

Answer 4

Perform early and lasts ~3 hours - if not performed properly and within 3 hours should do it

Exposure to cool, clean running water for 20 mins - more not effective

Never Ice - does more damage than good

Question 5

What does the primary survery/Ax of trauma in children involve?

Answer 5

1. ABCD
2. Adequate exposure
3. AMPLE history
   - allergies, medications, tetanus status, past medical/hospitalisations, last meal, event/environment surrounding accident
4. Imagine
   - CTB - if poor conscious state/AVPU, pupil signs or severe injury
   - XRAYs - lateral c-spine, chest +/- pelvis

Question 6

Red flags/risk factors for non-accidental injury?

Answer 6

Hx DHS involvement
Hx parental substance use, domestic violence, MH, poverty
Bruising - Patterned, tram track, periorbital
Location of injury important
Subdural haemorrphages, posterior rib fractures - signs of shaken baby syndrome

Question 7

If suspect NAI what should you do?

Answer 7

If <3 years ALWAYS

• Full Skeletal survey (XRs to cover whole body) - looking for signs of fractures AND
• Whole body bone scan

Consider imaging of head and neck - shaking