160. Ped Trauma Flashcards
(159 cards)
1
Q
__ mechanisms account for over 95% of childhood injuries
A
Blunt
2
Q
How are children unique from adults impacting their trauma evaluation and management?
A
- force more widely distributed throughout child’s body so more likely to have multi system injuries<br></br>2. yo pt - greater surface area to weight ratio - higher potential heat loss<br></br>3. can maintain BP despite sign hemorrhage so hypoT is a late finding<br></br>4. head to body ratio greater, brain les myelinatedan cranial bones are thinner = serious head injury<br></br>5r. liver and spleen more anterior with less protective musculature resulting in greater injury risk<br></br>6. kidney less protected<br></br>7. elasticity of chest wall for pulmonary injury without rib #<br></br>8. more tenuous SC blood supply and elasticity – predisposing to SCIWORA
3
Q
What two things do you worry about/consider compensated shock in a child?
A
- tachycardia<br></br>2. delayed cap refill
4
Q
What organs are more at risk in ped trauma than adult?
A
- head<br></br>2. liver<br></br>3. spleen<br></br>4. kidney<br></br>5. pulmonary injury without rib #<br></br>6. SCIWORA
5
Q
<img></img>
A
6
Q
ETT cuffed tube size in a child calculation
A
age in years/3<br></br>then add 3.5
7
Q
ETT tube depth calculation
A
ETT tube depth = size x3
8
Q
Chest tube diameter children calculation
A
4x ETT size
9
Q
Orogastric, nasogastric or foley size (diameter) calculation
A
2x ETT size
10
Q
Airway in a child - indications of upper airway obstruction
A
gurgling<br></br>stridor
11
Q
Airway in a child - indications for an ETI<br></br>4
A
- inability to ventilate with BMV or need for prolonged control<br></br>2. GCS </=8<br></br>3. Resp failure from hypoxemia or hypoventilation<br></br>4. worsening decompensated shock R to initial fluid resus
12
Q
What meds should be used for RSI in kids?
A
ketamine, etomidate<br></br>succ, roc
13
Q
Why might premedication fentanyl/lidocaine be less used to premedicate RSI in kids?
A
blunt rise of ICP supposedly but not evidence based, rosen’s doesn’t recommend
14
Q
Breathing peds - what factors can compromise ventilatory function?
A
-decreased LOC<br></br>-airway obstruction<br></br>-painful resp<br></br>-diaph fatigue<br></br>-direct pulmonary injury
15
Q
BMV small amount only for peds - why?
A
higher risk gastric inflation
16
Q
If gastric decompression in peds occurs due to BMV, how to manage this?
A
- oro or nasogastric tube
17
Q
Circulation peds - signs of poor perfusion
A
cool distal extremities<br></br>decreased peripheral pulse quality<br></br>delayed cap refill
18
Q
Circulation peds - vascular access options
A
- IV<br></br>2. IO
19
Q
Circulation peds - preferred IO placement
A
proximal medial tibia - below and directed away from humerus<br></br><br></br>other spots - proximal humerus<br></br>flat area of anterior distal femur<br></br>distall tibia
20
Q
What is a CI to IO placement?
A
fracture site
21
Q
Circulation peds - if necessary for central line - preferred initial option?
A
u/s guided fem line
22
Q
<img></img>
A
23
Q
Circulation peds - Where to perform a venous cut down IF only absolutely necessary in ped pt?
A
greater saphenous vein at ankle
24
Q
Circulation peds - who is a candidate for umbilical vein cannulation if enough of stump?
A
neonates up to 10d old
25
Circulation peds - fluid resus amount
20ml/kg warm iso crystalloid fluid over 10 mins
can give second if does not improve
can give second if does not improve
26
Circulation peds - fluid progression - when to go to blood
20mg/kg saline + repeat
then pRBC at 10ml/kg
then pRBC at 10ml/kg
27
n cases of massive
transfusion (blood products >40 mL/kg in an adolescent or >50 mL/
kg in a child/infant), it is important to add ? and ?
plasma
plt
plt
28
29
Although frequently used in non-traumatic pediatric
surgery, use of tranexamic acid in injured children is ?
rare
30
Dose (under study per Rosen's) if TXA required to be used in peds?
injured children (15 mg/kg over 20 minutes, then 2 mg/kg/h for 8
hours or 30 mg/kg over 20 minutes, then 4 mg/kg/h for 8 hours) is
currently under study
31
Disability in pediatrics assessment - check?
GCS as appropriate/AVPU
pupils
postuers
GLUCOSE check
pupils
postuers
GLUCOSE check
32
Exposure in ped pt - concern about uncovering is hypothermia - why is this bad in a trauma pt?
contributes to metabolic acidemia --> issues with cardiac contractility and speed, catechol responsiveness, plt function as well as renal and hepatic drug clearance
33
Exposure pediatric pt - how to maintain nomothermia?
increasing room temp
give warmed fluids and o2 and blood products
head wrap/warmer
give warmed fluids and o2 and blood products
head wrap/warmer
34
35
How does a <2 GCS score differ from >2
Eyes - same
Voice - 5 = coo/babble, 4- irritable/cries, 3-cries to pain 2 is same with sounds, 1 = none
M - 6 - spont movement, 5- withdraw to touch, 4 down is same
Voice - 5 = coo/babble, 4- irritable/cries, 3-cries to pain 2 is same with sounds, 1 = none
M - 6 - spont movement, 5- withdraw to touch, 4 down is same
36
Recommended that F be added to ABC of trauma for ?
family - in room/explained
37
Secondary survey in peds: includes?
usual head to toe
AMPLE hx
AMPLE hx
38
Tasks completed after secondary survey: 5
1. cont monitor VS
2. provision analgesia, cont r/a pain
3. abx
4.u/o measure
5.transport if necessary
2. provision analgesia, cont r/a pain
3. abx
4.u/o measure
5.transport if necessary
39
What might be an important HEENT secondary survey in peds considering NAT?
fundoscopic eval with retinal hemorrages
40
What is a seat belt sign?
erythema/abrasions, ecchymosis across chest or abdo from seat belt
41
Abdominal tenderness is present in approximately _% of
alert children with an intra-abdominal injury; however, the reliability
of the abdominal examination decreases drastically in patients with
GCS scores less than _.
75
14
14
42
If
there is a concern for urethral injury, a ? should
be completed prior to insertion of a urinary catheter to avoid further
injury.
retrograde urethrogram
43
Lab testing - pt at risk of hemorrhage?
- type and screen
- hemoglobin
- urea
- hemoglobin
- urea
44
Lab testing - concern for hepatic injury, test ?
liver transaminases as these acutely increase post trauma
45
Lab testing - which children are at risk for coagulatopathy and thus should be screened with INR and aPTT? (4)
1. GCS </=13
2. Hypotension
3. Mult or open #
4. Major tissue wounds
2. Hypotension
3. Mult or open #
4. Major tissue wounds
46
Lab testing - a ___ should be done to assess for blood to assist with kidney injury/urethrral injury
urinalysis
47
List of total LAB tests for peds if meet all critieria:
- hbg
- type and screen
- urea
-glucose
- AST, ALT
- coagulation studies (INR/ aPTT)
- urinalysis
-consideration of substances/tox screen
- pregnancy if indicated
- type and screen
- urea
-glucose
- AST, ALT
- coagulation studies (INR/ aPTT)
- urinalysis
-consideration of substances/tox screen
- pregnancy if indicated
48
What diagnostic imaging is helpful in kids?
-u/s fast
plain films after primary survey - CXR, pelvic XR: if hypoT on unstable pelvis on exam
plain films after primary survey - CXR, pelvic XR: if hypoT on unstable pelvis on exam
49
Data suggests the risk of radiation-induced malignancy is ? cranial CT scans and ? abdominal
CT scans.
1 per 5000 to 10,000
1 per 300 to 600
1 per 300 to 600
50
Important differences in the peds skull/head than adult that effect risks of trauma - what are these differences?
1. head is big and heavier compared to rest body mass - higher torque along cspine
2. sutures protective and detrimental as forces can transmit to give parenchymal injury in absence of skull #
3. less myelinated, higher water content --> shearing forces, higher risk DAI/post trauma seizure
2. sutures protective and detrimental as forces can transmit to give parenchymal injury in absence of skull #
3. less myelinated, higher water content --> shearing forces, higher risk DAI/post trauma seizure
51
What is an impact seizure? What testing?
brief seizure after insult with rapid return to normal LOC
most should undergo CT, but if normal mental status after this and normal CT, can be d/c home
most should undergo CT, but if normal mental status after this and normal CT, can be d/c home
52
Cerebral perfusion pressure equation
mean arterial pressure - intracranial pressure
CPP directly correlates with incr/decr MAP
CPP directly correlates with incr/decr MAP
53
Cerebral perfusion pressure - in head injury trauma, therapy should target a CPP greater than ? mmhg and ICP > _ mmhg
40
20
20
54
Signs and symptoms of increased intracranial pressure in infants and children -9
1.Headache
2.stiff neck
3. photophobia
4.altered state consciousness
5. persistent emesis
6. cranial nerve abnormalities
7. papilledema
8. Hypertension, bradycardia and hypoventilation
9. decort/decerebrate posturing
2.stiff neck
3. photophobia
4.altered state consciousness
5. persistent emesis
6. cranial nerve abnormalities
7. papilledema
8. Hypertension, bradycardia and hypoventilation
9. decort/decerebrate posturing
55
Key distinction in Signs and symptoms of increased intracranial pressure in neonates - 4
paradoxical irritability
split sutures
full fontanelle
setting sun sign
split sutures
full fontanelle
setting sun sign
56
57
What is a concussion?
functional brain injury after blow to head/fall/injury that shakes the brain within the skull
58
Should you image in concussion?
only if concerned about bleed
59
Caput succedaneum
hematoma in connective tissue layer - freely mobile, crosses suture lines
60
Subgaleal hematoma
hematoma within loose arealor tissue above periosteum
61
Cephalohematoma
collection of blood under periosteum
DOES NOT cross suture lines
DOES NOT cross suture lines
62
Peds head injury: Simple, linear, nondepressed # - tx
no therapy, good outcome, no hos
63
Peds head injury: factors related to poor outcome from skull fracture
1. fracture overlying a vascular channel like the middle meningeal a
2. depressed #
3. Diastatic fracture - # through suture lines --> can lead to a leptomeningeal cyst and # can grow
2. depressed #
3. Diastatic fracture - # through suture lines --> can lead to a leptomeningeal cyst and # can grow
64
Signs of basilar skulls fracture
1. periorbital subcutaneous hematoma
2. posterior auricular ecchymosis
3. CSF otorrhea or rhinorrhea
2. posterior auricular ecchymosis
3. CSF otorrhea or rhinorrhea
65
Peds head injury: cerebral contusions - result of ? and mainfest as ?
coup, countercoup forces
mult microhemorrhages
mult microhemorrhages
66
Peds head injury: cerebral contusions - symptoms
- AMS
-headache
-vomiting
-focal deficits on exam
-headache
-vomiting
-focal deficits on exam
67
Peds head injury: epidural hematoma - what is this?
often assoc with?
often assoc with?
bleeding from meningeal vessels
overlying skull fracture
overlying skull fracture
68
Peds head injury: epidural hematoma - classic triad
head injury
lucid interval
rapid deterioration as hematoma expands and compresses brain
lucid interval
rapid deterioration as hematoma expands and compresses brain
69
Peds head injury: subdural hematoma - often secondary to ?
rupture bridging veins
70
Peds head injury: subdural hematoma - seen in kids < ? most commonly
less than half have __ __
less than half have __ __
2
skull #
skull #
71
Peds head injury: subdural hematoma - when to worry about chronic?
NAT
72
Peds head injury: subdural hematoma - where on imaging might these raise concern for NAT?
multiple
sites, over areas other than the convexities, in the posterior fossa,
or the posterior interhemispheric fissure should raise suspicion for
nonaccidental trauma.
73
74
PECARN: <2yoz: when to image?
CT: AMS or GCS <15 or palpable skull #
if none
consider: LOC >5s, nonfrontal hematoma, not acting normal, severe mechanism: fall >3ft, MVC with ejection/rollover/fatality, bike or ped vs vehicle without helmet, struck by high impact object
if none - no image
if none
consider: LOC >5s, nonfrontal hematoma, not acting normal, severe mechanism: fall >3ft, MVC with ejection/rollover/fatality, bike or ped vs vehicle without helmet, struck by high impact object
if none - no image
75
PECARN >2y when to image
CT: AMS or GCS <15 or basilar skull #
if none
consider: LOC, hx emesis, severe headache, severe mechanism: fall >3ft, MVC with ejection/rollover/fatality, bike or ped vs vehicle without helmet, struck by high impact object
if none - no image
if none
consider: LOC, hx emesis, severe headache, severe mechanism: fall >3ft, MVC with ejection/rollover/fatality, bike or ped vs vehicle without helmet, struck by high impact object
if none - no image
76
How to treat suspected ICP in peds?
1. raise head of bed to 30 degrees
2. analgesia and sedation
3. ventilate with paco2 35-40
4. hbg >70
5. normothermia 35-38
6. correct coagulopathy
7. adequate hydration with boluses
If still - then 3% hypertonic saline between 2-5ml/kg over 15mins
Peds mannitol less evidence
2. analgesia and sedation
3. ventilate with paco2 35-40
4. hbg >70
5. normothermia 35-38
6. correct coagulopathy
7. adequate hydration with boluses
If still - then 3% hypertonic saline between 2-5ml/kg over 15mins
Peds mannitol less evidence
77
Moderate to severe head injury, consider tx with ? to prevent early post trauma seizure
pheny or keppra
78
What area of spinal column are most common in peds?
falls and mvc lead to:
TL
TL
79
MC # in kids for SCI injury
compression
80
In children <8, which area of SC is a # rare
cervical
in this age group usuallu C3 or above
in this age group usuallu C3 or above
81
As anatomic
features of the cervical spine approach adult patterns between ages 8
and 10 years, injuries are more common in the lower__spine,
and by age 15 years, the injury spectrum is similar to adult patients.
cervical
82
Most injuries typically described as SCIWORA can actually be seen on __
MRI
83
84
85
Anatomic differences in the pediatric c-spine - name 8
1. larger head size resulting in gr f/e injury
2.sm neck muscle mass - lig injur mc than #
3. anterior wedge appearance cervical vertebral body common
4. increased flex IS ligs
5. epiphysis at SP may mimic #
6.prevertebral space actually varies with ph of resp
7. posterior arches of all but c1 fuse 3-5y, c1 specifically 47
8. anterior c1 arch may not be visible until 1yo, fuses 7-10y
2.sm neck muscle mass - lig injur mc than #
3. anterior wedge appearance cervical vertebral body common
4. increased flex IS ligs
5. epiphysis at SP may mimic #
6.prevertebral space actually varies with ph of resp
7. posterior arches of all but c1 fuse 3-5y, c1 specifically 47
8. anterior c1 arch may not be visible until 1yo, fuses 7-10y
86
What 3p are highly
correlated with spinal cord injuries in kids?
paralysis
paresthesia
priapism
paresthesia
priapism
87
Incomplete cord lesion defn
preservation of some sensory or mo function below injury level
88
8 factors associated with cspine injury (by PECARN study)
1. AMS
2. focal neuro findings
3. neck pain
4. torticollis
5. substantial torso injury
6. conditions predisposing to cpisne injury
7. diving mech
8. high risk mo vehicle crash
2. focal neuro findings
3. neck pain
4. torticollis
5. substantial torso injury
6. conditions predisposing to cpisne injury
7. diving mech
8. high risk mo vehicle crash
89
Spine clearance peds: Based on literature and expert opinion, the authors rec-
ommend clinical clearance in children with...
1. GCS scores 14-15
2. Minotr mechanism of injury (ie no promt axial load, clothesline injury, high spee MVC, suspected NAT, fall from height >10ft)
3. no midline spine tenderness with full rom
4. normal head position
5. no assoc neuro deficits
6. no painful distracting injury
7. no hypot
8. no intoxication
2. Minotr mechanism of injury (ie no promt axial load, clothesline injury, high spee MVC, suspected NAT, fall from height >10ft)
3. no midline spine tenderness with full rom
4. normal head position
5. no assoc neuro deficits
6. no painful distracting injury
7. no hypot
8. no intoxication
90
91
An essential criterion for radiographic clearance of the cervical spine
is complete visualization of all seven cervical vertebrae to the C7 to T1
interface. The pre-dental space should be less than 5 mm in children
younger than 6 years old, and the prevertebral soft tissue space should
not be greater than one-half the vertebral body width above C4, and
not greater than the width of the vertebral body at C6. The four cervical
radiographic lines should be evaluated and the atlanto-occipital align-
ment assessed for dislocation
92
In children with GCS scores less than 14, we recommend __ imaging
cervical spine CT be obtained at the time of cranial CT imaging
93
A Power’s ratio greater
than 1 on imaging indicates ...
atlanto-occipital dislocation
94
95
Spinal vs neurogenic shock
Spinal shock is the loss of spinal reflexes below the site of injury, and
generally resolves in 1 to 24 hours as spinal reflexes return below the
site of injury. Neurogenic shock typically occurs with spinal cord inju-
ries above the mid-thoracic level, and should only be considered once
hemorrhagic shock has been excluded
96
Tx neurogenic shock
Treatment includes fluid administration, parasympathetic receptor
blocking agents (e.g., atropine), and vasopressors with chronotropic,
vasoactive, and inotropic characteristics (e.g., norepinephrine).
97
Pediatric rib fractures - common or not? why?
uncommon - less calcified ribs, therefore more rib flexibility
if present indicates ++ high force, look for other injuries
managed supportive care, same as adult
if present indicates ++ high force, look for other injuries
managed supportive care, same as adult
98
Children normally function near max of which lung capacity and why?
TLC
little change in child's chest wall circumference so impairs ability to increase FRC, therefore almost always max TLC
little change in child's chest wall circumference so impairs ability to increase FRC, therefore almost always max TLC
99
What is the initial screening test for thoracic injury in kids?
cxr - gets 50
% injury
% injury
100
Indications for a child to have a contrast enhanced CT chest?
evaluation trachea-bronchial or aortic /great vessel injury
101
Where to put a chest tube for PTX?
mid axillary line, then confirmed with CXR
102
What PTX can be observed in kids?
small <20% vol in spont breathing, alert, HD stable
103
All pneumothoraces undergoing
observation should be treated with? to speed reso-
lution
high flow oxygen
104
Pathophysiology of a tension PTX
pulmonary air leaks ocurring through one way valve can cause a tension PTX
increasing amount of trapped air within pleural cavity force mediastinal structures to opp side, compromising cardiac output
distension of neck veins from decreased venous return to heart
increasing amount of trapped air within pleural cavity force mediastinal structures to opp side, compromising cardiac output
distension of neck veins from decreased venous return to heart
105
Tension PTX treatment
14 gauge angiocath in 2nd ICS midclavicular line or tube thoracostomy in 4th ICS anterior to mid axillary line
106
When does an open PTX occur?
injured chest wall allows bi directional flow of air through wound
equalization of pressure atm and chest wall cavity prevents adeqaute lung expansion
equalization of pressure atm and chest wall cavity prevents adeqaute lung expansion
107
What to cover a small open PTX with?
sterile petroleum gauze and separate incision for chest tube
108
If open PTX too large for occlusive dressing, what to do?
intubation with mech ventilation and chest thoracostomy
109
HTX: signficiant bleed can occur as a result of which 3?
intercostal vessels
internal mammary vessels
lung parenchyma
internal mammary vessels
lung parenchyma
110
HTX: how to manage small vs large
small - watch
large: tube thoracostomy
large: tube thoracostomy
111
In the supine patient with a simple pneumothorax,
chest tubes are directed superiorly; in hemopneumothorax, however,
they are directed ?
posteromedially
112
Indication for massive HTX tx with open thoracostomy
evacuation of blood >15ml/kg of blood immediately on placement of Chest tube
persistent blood loss >2-4ml/kg/h over 3 hours
persistent HD instability or
continued air leak
persistent blood loss >2-4ml/kg/h over 3 hours
persistent HD instability or
continued air leak
113
Most common thoracic injury in kids
pulmonary contusions
114
Pulmonary contusion in kids - how does this occur?
compliance of rib cage makes more susceptible
injury to cap memranges allows blood to collect within interstitial spaces --> hypoxia and resp distress
close monitoring required
injury to cap memranges allows blood to collect within interstitial spaces --> hypoxia and resp distress
close monitoring required
115
Progression if pulmonary contusion becomes significant?
PPV or ECMO
116
What might be caused by a sudden increase in intraabdominal pressure?
traumatic diaphragmatic hernia
117
What side do most diaphragmatic hernias occur from in a trauma?
left as liver hinders herniation of bowel on the right
118
How to manage traumatic diaphragmatic hernia?
NG tube
AVOID BMV as this can herniate into chest
AVOID BMV as this can herniate into chest
119
herniation stomach into L chest
120
Plain radiograph demonstrating a right sided tension
pneumothorax with shift of the mediastinal structures to the left.
The mediastinum is more mobile in children resulting in rapid ven-
tilatory and circulatory collapse when under tension.
121
Most common finding of a cardiac contusion?
sinus tach
122
In patients with symptoms, an ? is indicated
Echo
123
Typically in cardiac contusion, trops are
high - not normal!
124
Significant cardiac contusions can cause
dysrhthymias
impaired myocardial function
impaired myocardial function
125
Cardiac tamponade defn (from trauma)
extravasated blood fills pericaridal space, impairs cardiac filling in diastole
126
Cardiac tamponade symptoms
tachyc
distant heart sounds
narrow pulse pressure
JVD
pulsus paradoxus
distant heart sounds
narrow pulse pressure
JVD
pulsus paradoxus
127
What can rapidly identify cardiac tamponade?
fast
128
How to tx cardiac tamponade
definitive thoracotmy/pericardial window
129
Commotio cordis
blunt trauma to ant chest wall causing cessation of normal cardiac function - immediate dys or vent fib refractory to resus
130
ED thoracotomy more effective for __ trauma
penetrative
131
When is a L ant thoracotomy warranted for penetrating chest trauma
CPR <15 mins
132
Contraindications for ED resus thoracotomy after out of hospital CPR 2
1. blunt trauma with CPR >10 mins with asystole, no signs of life on presentation without u/s evidence of cardiac tamponade
2. penetrating trauma with CPR >15 mins and asystole with no signs of life on arrival without u/s evidence cardiac tamponade
2. penetrating trauma with CPR >15 mins and asystole with no signs of life on arrival without u/s evidence cardiac tamponade
133
Most common abdo injuries
1. lap belt injuries are most common in children and adol - intestinal injuries and 2) Chance/horiz spinal fractures
134
Signs and symptoms of abdo injury in children
tachypnea
abdo tenderness
signs of shock
abdo tenderness
signs of shock
135
What sign makes more likely to have intra abdo injuries?
erythema/ecchymosis/abrasion
136
What screening lab tests are useful for concern of abdo injury in kids?
AST >200, ALT >125, hematuria or hematocrit <30%
137
138
PECARN abdo injury rule - why used?
ct or not
139
PECARN abdo injury rule - when to CT?
1. evidence abdo wall injury/seatbelt sign or GCS <14 with blunt trauma
2. abdo tender
3. thoracic wall trauma, complaints of abdo pain, decreased breath sounds, emesis
2. abdo tender
3. thoracic wall trauma, complaints of abdo pain, decreased breath sounds, emesis
140
Indications for laparatomy in children with abdo:
intrabdo injuries with HD instability unresponsive to fluids
transfusion >50% blood volume
tx GI injuries
penetrating abdo trauma
peritonitis
transfusion >50% blood volume
tx GI injuries
penetrating abdo trauma
peritonitis
141
When is pelvic bone imaging indicated?
HD instability
decreased LOC
pelvic bone tender/unstable
hematuria/signficiant distracting injuries
decreased LOC
pelvic bone tender/unstable
hematuria/signficiant distracting injuries
142
What is the most commonly injured abdo organ in kids?
spleen
143
Splenic injury in kids - findings
LUQ radiating to shoulder
144
What imaging is best to see splenic injury?
abdo CT
145
Due to organ mobilitywith lack of protective mechanism, the kidney in kids is ___ susceptible to injury
more
146
Best screening of renal injury by ? test
urinalysis
147
Gross hematuria requires which test?
Abdo CT - risk injury 50%
148
What is considered a + urinalysis in kidney injury?
5-100 RBC/HPF (wide range)
149
For most patients, initial
CT scan of the abdomen to assess for genitourinary injury is indicated
when there is... (3)
gross hematuria
microscopic hematuria with abdo pain/pelvic trauma
penetrating injury to abdomen
microscopic hematuria with abdo pain/pelvic trauma
penetrating injury to abdomen
150
GI injuries in peds: abdo CT useful?
95% of injuries caught - intraperitoneal air, bowel wall thickening, bowel
wall enhancement, mesenteric infiltration, and vascular contrast
extravasation
151
Pancreatic injury peds: best test
lipase and amylase best after 24-48 hours after injury
CT only 50% pancreatic injury fails to correctly grade injury
CT only 50% pancreatic injury fails to correctly grade injury
152
Penetrating injury to abdomen - when is laparatomy indicated?
1. HD instability
2. Peritonitis
2. Peritonitis
153
Straddle injury defn
child falls,
striking their genitals and perineum on a hard object, most commonly
bicycles and playground equipment
154
Straddle injury - what to do to assess?
PE
155
Straddle injury - assess __ and ability to __
hematuria
ability to void
ability to void
156
Straddle injury - in males, consider ?
scrotal u/s
157
Straddle injury - definitive care if :
extensive lacs
vaginal bleed
large hymenal tear
scrotal laceration through dartos layer
urethral injury
vaginal bleed
large hymenal tear
scrotal laceration through dartos layer
urethral injury
158
7. A 12-year-old male fell while climbing over a 12-foot barbed-wire
fence and sustained a deep 10-cm laceration to his medial left thigh.
Parents bring him to the ED directly from the scene. There is active
oozing from the laceration. What is the first step in the manage-
ment of this patient?
a. Apply a tourniquet to the leg.
b. Begin with a primary survey and assess the patient’s airway and
b. Begin with a primary survey and assess the patient’s airway and
breathing.
c. Obtain intravenous (IV) access and begin blood transfusion
c. Obtain intravenous (IV) access and begin blood transfusion
immediately.
d. Pack the wound to decrease hemorrhage.
d. Pack the wound to decrease hemorrhage.
b
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8. Which of the following statements regarding imaging of a multi-
trauma pediatric patient is correct?
a. A negative computed tomography (CT) scan of the cervical spine
rules out spinal cord injury, and if normal, immobilization can be dis-
continued.
b. A negative focused assessment with sonography in trauma
(FAST) examination rules out traumatic intra-abdominal injury,
making a CT scan unnecessary.
c. In a hemodynamically stable pediatric trauma patient, CT imag-
ing should be completed before transfer to a pediatric trauma
facility, even if it delays transfer.
d. In a hemodynamically stable pediatric patient with a high level
of concern for intra-abdominal trauma, CT scan is the imaging
test of choice.
d
