TRAUMA: PHYSIOLOGIC CHANGES, EVALUATION, AND MANAGEMENT (AB)

Question 1

What is the leading cause of death among children >1 year old?

Answer 1

Injury or trauma

Question 2

What is the leading cause of death in people aged 1 to 19 years?

Answer 2

Motor vehicle collisions

Question 3

What are the factors influencing trauma management and outcomes in children?

Answer 3

Mechanisms of injury, anatomic variations compared to adults, physiologic responses

Question 4

What is the most common type of trauma in pediatric patients: blunt or penetrating?

Answer 4

Blunt trauma

Question 5

How do age and gender influence pediatric trauma patterns?

Answer 5

Males more commonly affected; 14-18 years exposed to contact sports, gun violence, and driving; infants/toddlers - falls are most common

Question 6

What is the most common cause of trauma in infants and toddlers?

Answer 6

Falls

Question 7

What are the components of the pediatric primary survey?

Answer 7

Airway, Breathing, Circulation, Disability (neurologic assessment), Exposure/Environment

Question 8

What is the first priority in pediatric trauma management?

Answer 8

Airway control

Question 9

How does pediatric airway anatomy differ from adults?

Answer 9

Large head, short neck, anterior larynx, floppy epiglottis, short trachea, large tongue

Question 10

What is the formula for endotracheal tube size in children?

Answer 10

(Age + 16) ÷ 4

Question 11

What ET tube size would be used for a 5-year-old?

Answer 11

5.25 (approximately size 5)

Question 12

What type of ET tube is recommended for children younger than 8 years old?

Answer 12

Uncuffed ET tube

Question 13

Why are uncuffed ET tubes preferred in children under 8 years old?

Answer 13

To avoid tracheal stenosis

Question 14

What can gastric distention do to breathing in pediatric trauma patients?

Answer 14

Severely compromise respiration

Question 15

When should a nasogastric tube (NGT) be placed during pediatric trauma resuscitation?

Answer 15

Early, if there is no head injury

Question 16

How should pneumothorax or hemothorax be managed in pediatric trauma?

Answer 16

Prompt treatment

Question 17

What is the earliest measurable sign of hypovolemia in children?

Answer 17

Tachycardia

Question 18

What is usually the first vital sign change indicating hypovolemia in adults?

Answer 18

Hypotension

Question 19

What are other signs of hypovolemia in children?

Answer 19

Changes in mentation, delayed capillary refill, skin pallor, hypothermia

Question 20

What IV access sites are preferred in neonates and infants?

Answer 20

Jugular vein

Question 21

What IV access sites are preferred in older children?

Answer 21

Antecubital fossae, cut-down into saphenous vein at groin

Question 22

What is an alternative temporary IV access method in children?

Answer 22

Intraosseous cannulation

Question 23

How long can intraosseous access be safely used?

Answer 23

Up to 24 hours

Question 24

What is the risk of prolonged intraosseous access?

Answer 24

Osteomyelitis (infection) or osteoporosis

Question 25

What fluid bolus is given to pediatric patients with signs of volume depletion?

Answer 25

20 mL/kg bolus of saline or lactated Ringer's

Question 26

What is the next step if a pediatric patient does not respond to 3 fluid boluses?

Answer 26

Transfuse 10 mL/kg of packed RBCs

Question 27

What are common sites of internal bleeding in pediatric trauma?

Answer 27

Chest, abdomen, pelvis, extremity fractures, large scalp wounds

Question 28

How can hypothermia be prevented during pediatric trauma resuscitation?

Answer 28

Warmed fluids, external warming devices

Question 29

What imaging modality is most valuable for abdominal trauma in children?

Answer 29

Abdominal CT scan with IV and oral contrast

Question 30

When is diagnostic laparoscopy considered in pediatric trauma?

Answer 30

Significant abdominal tenderness

Question 31

What is the purpose of a FAST exam in trauma?

Answer 31

Identify hemoperitoneum or abdominal fluid in blunt trauma

Question 32

Why is the FAST exam not widely accepted in pediatric trauma?

Answer 32

Pediatric surgeons promote non-operative management for most solid organ injuries

Question 33

In stable pediatric trauma patients

Answer 33

what is the preferred management for most solid organ injuries?

Question 34

What does a positive FAST exam in stable pediatric patients indicate?

Answer 34

Does not automatically require surgery

Question 35

What does a positive FAST exam in stable adults indicate?

Answer 35

Surgical exploration

Question 36

What is fetal intervention in pediatric surgery?

Answer 36

Prenatal procedures to correct defects that could have devastating consequences if untreated

Question 37

What does fetal surgery require for success?

Answer 37

Careful patient selection, multidisciplinary team, accurate prenatal imaging (US, MRI)

Question 38

What is the maternal risk during fetal surgery?

Answer 38

Uterine bleeding from uterine relaxation

Question 39

What are fetal risks associated with fetal surgery?

Answer 39

Premature labor, amniotic fluid leak

Question 40

When is fetal surgery recommended?

Answer 40

When expected benefit outweighs risks of postnatal care

Question 41

What conditions may benefit from fetal intervention?

Answer 41

Large congenital lung lesions with hydrops, large teratomas with hydrops, twin-twin transfusion syndrome, congenital lower urinary tract obstruction, myelomeningocele, fetal tracheal occlusion for congenital diaphragmatic hernia

Question 42

What does EXIT stand for in EXIT procedure?

Answer 42

Ex Utero Intrapartum Treatment

Question 43

What is the purpose of the EXIT procedure?

Answer 43

Secure airway when airway obstruction is predicted at delivery due to large neck mass or congenital tracheal stenosis

Question 44

What is crucial for success during the EXIT procedure?

Answer 44

Maintain uteroplacental perfusion until airway is secured

Question 45

How long can uteroplacental perfusion be maintained during EXIT?

Answer 45

20-30 minutes

Question 46

What happens if perfusion exceeds 30 minutes during EXIT?

Answer 46

Catastrophic outcomes

Question 47

How is the fetal airway secured during EXIT?

Answer 47

Orotracheal intubation or tracheostomy while still connected to placenta