Trauma Modifiers

Question 1

What % blood loss does tachycardia/hypoTN in child signify?

Answer 1

25-50%

Question 2

What are the doses of blood product in a paediatric MTP protocol?

Answer 2

Everything 10ml/kg!

PRBC
FFP
Plts
+-cryo

Question 3

What is paediatric TXA dose?

Answer 3

10-15mg/kg IV (up to 1g)

Question 4

Considerations in OBSTETRIC trauma approach:

Answer 4

Usual obs resus stuff: OER, physiol differences, L lateral tilt, CTG if 24/40+ etc.

Specific to trauma:
A
- Usual

• Fetal distress on CTG may be first marker of shock

B
- Higher finger/tube thoracostomy 3rd/4th IC space
- NGT early

C
-Higher blood vol (100ml/kg)
-Higher fluid resus 30ml/kg
-May not be hypotensive until 30% blood volume lost
- BGH. If Rh neg, Kleihaur and antiD/IG

D
-Must examine for obstetric injury
—> Firm/contracting uterus (preterm labour)
—> Tender uterus: (abruption)
—> Tender/ fetal part felt/ loss of station: (uterine rupture)
—> PV exam: (fetomaternal haemorrhage, ROM, labour, cord prolapse etc.)

-CTG min 4 hours post, repeated next day.

_________

CONSIDER INTIMATE PARTNER VIOLENCE- pregnant is RF

https://trauma.reach.vic.gov.au/sites/default/files/Obstetric%20Trauma%20Guideline_Ver%201.0_25092014_complete.pdf

Question 5

Traumatic uterine rupture:

Answer 5

High force injury

RF: previous Csection/ scar

Incomplete: visceral peritoneum intact
Complete: contents spill into abdomen

Tender
Disrupted contour
Fetal part/s felt
Loss of fetal station
Haemoperitoneum

–> Haemostatic resus
—> Laparotomy

Question 6

Usual uterine blood flow:

Answer 6

800 - 1000ml per minute

Potential for massive haemorrhage.

Question 7

Considerations in GERIATRIC trauma:

Answer 7

And consider ELDER ABUSE

Question 8

Injury patterns in PAEDIATRIC trauma:

Answer 8

Larger, heavier heads and weak necks
—> more TBI and upper Cspine injury
—> SCIWORA <8

Smaller and softer airways
—> Sensitive to positioning ++
—> Small swelling = obstruction
Infants nose-breathers

Springy skeleton
—> Significant internal injury without fracture

Thin abdominal wall and liver/spleen not well protected by rib cage
—> Susceptible to intraabdo injury +
—> Handlebars dangerous

Greater SA:V
—> hypothermia

NAI!!

Question 9

Pregnancy-specific injuries in trauma:

Answer 9

Abruption
Rupture
Premature labour
Amniotic fluid embolism
Fetomaternal haemorrhage.