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paediatrics > The Injured Child > Flashcards

The Injured Child Flashcards

1
Q

Why is trauma an issue?

A
  • Commonest cause of death from age 5 to 50
  • M>F 3:1 (death by injury)
  • Can cause multi-system injury
  • Early intervention can prevent death but prevention of incident is always better
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2
Q

What type of trauma is more common?

A

Blunt»> penetrating

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3
Q

Why do children sustain injuries?

A
  • Development (anatomy, behaviour, locomotor, physiological and psychological)
  • Environement (is it child friendly?)
  • Those around them
  • More likely to take risks
  • Cannot necessarily understand warnings
  • Inquisitive in nature
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4
Q

What type of injuries do children sustain?

A
  • Fractures
  • Wounds
  • Burns and scalds
  • Head injuries
  • Drowning
  • Other
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5
Q

What types of fractures can occur in children?

A
  • Buckle
  • Greenstick
  • Clavicular fractures
  • Toddler fractures
  • Growth plate injuries
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6
Q

What are buckle fractures?

A
  • Most common type seen in paediatrics

- Bone buckles due to plasticity of child bones

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7
Q

What are greenstick fractures?

A
  • Bone fails in compression leading to hinge type fracture

- Z-shaped deformities can occur due to the tendons pulling

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8
Q

Why do clavicular fractures differ from other types of fractures?

A
  • Membranous calcification so heals like a skull bone

- Only 1 x-ray usually required (do not need multiple views)

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9
Q

What are toddler’s fractures?

A
  • Fractures that occur usually on the shin .

- Related to children starting to walk, tripping and twisting their ankles

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10
Q

What are growth plate injuries?

A
  • Growth plate point of weakness in long bone so can be injured
  • Often-break around the growth plate
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11
Q

What classification system is used for growth plate injuries?

A

Salter-Harris classification

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12
Q

What is important to establish with penetrating wounds?

A

Base and depth of wound

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13
Q

What should be your first thought when you see as shocked patient that has been in a fire?

A

What other injuries does this person have

-Shock is a late presentation. Early shock is an indicator of other injuries

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14
Q

What confounding factors are there in trauma?

A
  • Cold
  • Alcohol
  • Drugs
  • Hypoglycaemia
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15
Q

Why does a child’s size influence injuries sustained?

A

Smaller target
-Relatively greater amount of energy is absorbed for the same force of impact

Large surface area:volume ratio
-Heat loss significant in small children

Relatively large head
-Easily injured

Smaller mass

  • Drug doses and fluid requirements differ
  • Different equipment and techniques
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16
Q

Why does a child’s skeleton influence injuries sustained?

A

Incompletely calcified so it is:

  • Soft
  • Springy
  • Deforms rather than breaks
  • Poor at absorbing energy

Provides protection to vital organs

17
Q

Why does a child’s ‘insides’ influence injuries sustained?

A

Less elastic connective tissue
-Shearing and de-gloving

Crowding of poorly protected vital organs
-Liver, spleen, bladder and intra-abdominal

18
Q

How does a child’s metabolism influence injuries sustained?

A

Thermoregulation

  • Little brown fat and immature shivering
  • Pokilothermic
  • Environmental considerations e.g. RTCs

Hypoglycaemia

  • Little glycogen stored in liver
  • Exacerbated by hypothermia and vice versa
  • Develops quickly in sick children
19
Q

How can you establish the mechanism of injury?

A
  • Good history
  • Pictures, videos etc.
  • Do the injuries fit with the story?
20
Q

Give examples of injury patterns.

A
  • SCIWORA
  • Lap belt syndrome
  • Waddell’s triad : child hit straight on by car
21
Q

What does SCIWORA stand for?

A

Spinal cord injury without radiological abnormality

22
Q

What is Waddell’s triad?

A
  • Femoral fracture
  • Head injury
  • Trunk injury
23
Q

What are the long term effects of injury on children?

A

Psychological recovery from trauma

Effects on normal growth and development
-Classica example Salter Harris type 5 which cannot be detected until growth arrest occurs

24
Q

What are the normal vitals for <1 years?

A

RR
30-40

HR
110-160

SBP
70-90

25
Q

What are the normal vitals for 2-5 years?

A

RR
25-30

HR
95-140

SBP
80-100

26
Q

What are the normal values for 5-12 years?

A

RR
20-25

HR
80-120

SBP
90-110

27
Q

What are the normal values for >12 years?

A

RR
15-20

HR
60-100

SBP
100-120

28
Q

What can cause respiratory depression?

A
  • Poisoning
  • Convulsions
  • Raised ICP (head injury, acute encephalopathy)
29
Q

What can cause circulatory failure?

A

Fluid loss

  • Gastroenteritis
  • Burns
  • Trauma

Fluid malabsorption

  • Sepsis
  • Anaphylaxis
  • Heart failure
30
Q

What is the 1st peak of deaths?

A
  • Die on scene
  • Un-survivable major vessel or brain injury

Prevention is the only treatment

31
Q

What is the 2nd peak of death?

A
  • Die from significant ABCD problems unless adequately resuscitated
  • Platinum 10 minutes and golden hour
32
Q

What is the 3rd peak of deaths?

A
  • Delayed deaths despite resuscitation, surgery and ICU

- Due to multi-organ failure or sepsis usually

33
Q

What is the aim of trauma resuscitation?

A

To restore normal tissue oxygenation as quickly as possible

34
Q

What is the universal approach to trauma

A
  • Cat haem control
  • Airway with c-spine
  • Breathing and ventilation
  • Circulation with haem control
  • Disability and glucose
  • Exposure and environment
35
Q

What type of injuries should be identified during a primary survey?

A

ATOM FC

  • Airway
  • Tension pneumothorax
  • Open pneumothorac
  • Massive pneumothorax
  • Flail chest
  • Cardiac contusions
36
Q

What is the order of trauma care?

A
  • cABCDE
  • Primary survey
  • Secondary survey
  • Emergency treatment
  • Definitive care
  • Reassessment
37
Q

How do you determine a child’s weight?

A

< 1 year
(0.5 x age in months) +4

1-5 years
(2x age) +8

6-10 years
(3x age) + 7

38
Q

What system can be used to estimate a child’s weight?

A

Broselow system

paediatrics (37 decks)

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