The injured child

Question 1

Which gender is most likely to die from injury?

Answer 1

Boys 3x more likely to die from injury than girls

Question 2

What type of trauma is more common?

Answer 2

Blunt trauma > penetrating trauma

Question 3

What injuries do children sustain?

Answer 3

Fractures
Wounds 
Burns and scalds
Head injury 
Drowning

Question 4

Associations with injury in children

Answer 4

cold
alcohol
drugs
hypoglycaemia

Question 5

Why do children injure differently?

Answer 5

Different anatomical features
Different physiological and psychological responses to injury 
Different spectrum of injury patterns 
Size
Skeleton 
Inside the body 
Metabolism

Question 6

Size affecting injuries in children

Answer 6

Smaller target
- greater amount of energy is absorbed for the same force of impact 
Larger surface area:volume ratio 
- heat loss significant in children
Relatively large head
- easily injured 
Smaller mass
- drug doses and fluid requirements differ

Question 7

Features of the childs skeleton

Answer 7

Incompletely calcified 
- soft
- springy 
- deforms rather than breaks 
- poor at absorbing energy 
Provides less protection for vital organs

Question 8

Features of inside a childs body in respect to injury

Answer 8

Less elastic connective tissue
- shearing and degloving
Crowding of poorly protected vital organs
- liver, spleen, bladder are all intraabdomainl

Question 9

Thermoregulation in children in injuries

Answer 9

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

Question 10

Hypoglycaemia in children with injuries

Answer 10

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

Question 11

Injury patterns - SCIWORA

Answer 11

Spinal 
Cord
Injury 
Without
Radiological 
Abnormality

Question 12

Why can communication difficulties be present in a child with an injury?

Answer 12

Too young or afraid to describe symptoms
Have to rely on non verbal cues
Good rapport essential

Question 13

What does fear affect?

Answer 13

Vital signs

Question 14

Long term effects of injury on children

Answer 14

Psychological recovery

Effects on normal growth and development

Question 15

Respiratory failure features

Answer 15

Resp obstruction 
- birth asphyxia
- croup 
- epiglottitis
- foreign body inhalation 
- bronchiolitis
- asthma
- pneumothorax
Resp depression 
- poisoning
- convulsions
- Raised ICP

Question 16

Causes of Raised ICP

Answer 16

head injury
Acute encephalopathy
- meningitis / encephalitis

Question 17

Life threatning traumas

Answer 17

Respiratory failure

Circulatory failure

Question 18

Features of circulatory failure

Answer 18

Fluid loss
- gastroenteritis
- burns 
- trauma 
Fluid maldistribution 
- sepsis
- anaphylaxis 
- heart failure

Question 19

When is the first peak of deaths?

Answer 19

Die instantaneously
Die at the scene
Un survivable major vessel and brain injury

Question 20

What is the only treatment?

Answer 20

Prevention

Question 21

What is the second peak of deaths?

Answer 21

Die from significant ABCD problems unless adequately resuscitated

• platinum ten minutes
• golden hour

Question 22

What is the aim of trauma resuscitation?

Answer 22

To restore normal tissue oxygenation as quickly as possible

Question 23

What is done to treat trauma

Answer 23

cABCDE
primary survery and resus
2ndry survery 
emergency treatment 
definitive care
reassessment

Question 24

Primary survey of cABCDE

Answer 24

catastrophic haemorrhage control 
Airway with C spine - remember O2
Breathing with ventilation 
Circulation with haemorrhage control 
Disability 
Exposure/Environment 
Dont ever forget glucose

Question 25

Major risk factors for sudden infant death syndrome

Answer 25

Prone sleeping
Parental smoking
Bed sharing
Hyperthermia and head covering 
Prematurity

Question 26

What is the most significant factor in the cause of SIDS?

Answer 26

Co sleeping

Question 27

The most common causes of arrest in children are what?

Answer 27

Respiratory

Question 28

Protective factors of sudden infant death syndrome

Answer 28

Breastfeeding
Room sharing
Use of dummies

Question 29

What is the triad for shaken baby syndrome?

Answer 29

Retinal haemorrhages
Subdural haematoma
Encephalopathy

Question 30

Why at the start of paed CPR do you start with 5 rescue breaths?

Answer 30

A child is more likely to have collapsed due to respiratory causes

Question 31

Where is the best places to check for a pulse in a child under 1 y/o?

Answer 31

Brachial

Femoral

Question 32

Where is the best places to check for a pulse in a child > 1 y/o?

Answer 32

Femoral

Carotids