Trauma in the child

Question 1

When should you get an urgent head CT - within 1 hour (adult)

Answer 1

• GCS < 13 on initial assessment
• GCS < 15 at 2 hours after injury on assessment
• Suspected open or depressed skull fracture
• Any sign of basal skull fracture ·
• Post-traumatic seizure
• Focal neurological deficit
• More than one episode of vomiting since the injury

Question 2

What clinical features may you see in a basal skull fracture

Answer 2

• panda eyes
• battles sign
• haemotympanum
• CSF leakge from ear or nose

Question 3

When should you get an urgent head CT - within 1 hour (child)

Answer 3

• Suspicion of non-accidental injury
• Post-traumatic seizure, but no history of epilepsy ·
• On initial assessment GCS <14, or for children under 1 year GCS (paediatric) < 15
• At 2 hours after the injury GCS < 15
• Suspected open or depressed skull injury or tense fontanelle.
• Any sign of basal skull fracture
• Focal neurological deficit
• For children under 1 year, presence of bruise, swelling or laceration
  of more than 5 cm on the head

Question 4

What pathology would cause tracheal deviation to the left

Answer 4

• left sided lung collapse - moves to left to fill the voi

- Right hemithorax pushes the trachea to the left - tension pneumothorax

Question 5

Why are children more susceptible to pulmonary contusions

Answer 5

A childs’ chest wall is very compliant so rib fractures don’t frequently occur,
However, it also doesn’t dissipate the force so force of impact is directly transferred to the lungs

Question 6

What would pulmonary contusions look like on CXR

Answer 6

bilateral patchy changes

Question 7

What is the pathophysiology of lung contusions

Answer 7

Blood and fluid fill the alveoli creating a ventilation/perfusion mismatch
This lease to hypoxia

Question 8

What is the management of lung contusions

Answer 8

O2 + analgesia

Question 9

When should you et an urgent CT C spine

Answer 9

• GCS < 13 on initial assessment
• Intubation
• A definitive diagnosis of cervical spine injury is required urgently (e.g. before surgery)
• Other body areas are being scanned for head injury or multi-region trauma
• Focal peripheral neurological signs
• Paraesthesia in the upper or lower limbs

Question 10

When should you get three-view cervical

spine X-rays within 1 hour

Answer 10

Neck pain or tenderness and dangerous mechanism of injury e.g. axial load to head (diving) or fall from 1m or 5 steps