Week 12: Pediatric Trauma, Burns, Syndromes Flashcards
Pediatric Trauma
Injuries are the most common cause of death within the US for children older than _____ year of age.
________ injuries are the leading cause of death among children.
Most traumatic injuries in children result from:
- 1
- Head
- MVA
- Falls
- Nonaccidental trauma
- Drowning
- Extremes of temperature
Trauma Scoring Systems
Glasgow Coma Scale (GCS) and the modified GCS
Pediatric Trauma Score (PTS)
ABCs of Resuscitation
A =
B =
C =
D =
E =
A = Airway with cervical spinal control
B = Breathing & Ventilation (O2 & SaO2)
C = Circulation with hemorrhage control
D = Disability and neurologic control
E = Exposure & environmental control
Surveys
Primary survey –
Secondary survey –
ATLS course (Advanced Trauma Life Support)
- incorporates the “ABC’s” and life-threatening injuries are identified and treated
* Airway
* Breathing
* Circulation and Access
* Disability (Neurologic Assessment)
* Exposure - other injuries that contribute to significantly to illness and deaths are identified and treatment is instituted
SAMPLE Report
S
A
M
P
L
E
Preoperative Evaluation
SYMPTOMS
ALLERGIES
MEDICATIONS
PAST MEDICAL HISTORY
LAST MEAL
EVENTS LEADING TO INJURY
Vital signs
Airway/cervical spine evaluation
Planned surgical procedure
List of known injuries
Management since arrival
Relevant laboratory/imaging results
Past medical/surgical history/family history
Allergies/current medications
Fasting time
Figure 39-1
Management of pediatric trauma patients
CV
Skin
Renal
CNS
review
Criteria for Early Intubation
- Cardiac arrest
- Clinical signs of shock
- Hypoxia
- Hypercarbia
- Signs of developing airway obstruction
- Head injury with decrease in mental status
- Burn injury with airway involvement
- Combativeness
- Chest trauma with dyspnea
Fasting Duration
It is common to consider all trauma patients at _________ regardless of the time of last oral intake.
Delayed gastric emptying & distention
Major injury
Pain
Anxiety
Opioids
- risk for aspiration
Causes of airway abnormalities
Congenital syndromes
Acquired conditions
Fluid Resuscitation
- Goal is to maintain _______ in the presence of ongoing blood loss and/or third-spacing
- Colloids, such as _________
- PRBCs, FFP, Platelets and Cryoprecipitate and _______
- normovolemia
- 5% albumin
- Factor VIIA
Fluid Management
- Consider ______ solutions
- Avoid _______ solutions, especially when concerned with CNS injury
- Monitor blood glucose
- Per current literature, blood glucose should be maintained less than _____-_________, depending upon your facility protocol
- isotonic
- dextrose-containing
- 130-200
Vascular Access
Establish IV access ASAP!
Intraosseous (IO) access if IV cannot be established
Induction: Trauma
- Rapid sequence induction
- Consider hemodynamic status
- If less than 10% volume deficit (normotensive), then consider ______&_________
- If 10-20% blood loss (normotensive and HR <110), then consider _____ or _____ and______.
- If your patient has > 25% blood loss (hypotensive, tachycardia, respiratory distress, anuria, cold extremities) then you must be extremely cautious with the aforementioned agents because of hemodynamic instability!
- propofol & SCh
- Ketamine (1 – 2 mg/kg) or Etomidate (0.2 - 0.3 mg/kg) and SCh
-
Specific Injuries
- Head injuries
- Cervical spine injuries
- Facial trauma
- __________ (68% of all bites > ____ years of age)
- Soft-tissue neck trauma
- Chest trauma
- Abdominal trauma
- Lawnmower related injuries
- Skeletal injuries
- Abuse
Dog bites; 5
______________ is the leading cause of morbidity and mortality resulting from trauma in children.
Results in life long disability and significant expense.
Traumatic Brain Injury (TBI)
Head Injuries
- Adequate venous drainage (_____ degree, heads up position)
- Adequate oxygenation
- Avoidance of hypotension
- +/- Maintenance of slight hypocarbia (PaCO2 of ____ to ____)
- Monitor ICP (intraventricular catheters and subarachnoid bolts) and CBF (SVO2)
- Remember that fontanelles allow for expansion to a point.
- 30
- hypocarbia (35 to 38)