The injured child

Question 1

What are the main differences between adult and child anatomy which have an effect on the presentation of trauma

Answer 1

• Size
• Skeleton
• Metabolisms
• What is inside

Question 2

What are the considerations to be made on size?

Answer 2

• Greater amount of energy is absorbed for same force of impact
• Large SA: V ratio- greater heat loss
• Large head: easily injured
• Smaller mass:
  o Drug dose and fluid requirement differ
  o Different equipment and tecniques

Question 3

what are the considerations to be made on skeleton

Answer 3

-Incomplete calcification 
o	Soft 
o	Springy 
o	Deforms rather than breaks
o	Poor at absorption 
-Provides less protection for vital organs

Question 4

What are the considerations to be made on Insides?

Answer 4

• Less elastic tissue : shearing and de-gloving

- Crowding of poorly protected vital organs e.g. liver, spleen and bladder and intra-abdominal

Question 5

What are the considerations to be made on metabolism

Answer 5

-Thermoregulation
o Little brown fat and immature shivering
o Pokilothermic: inability to control body temp
o Environmental considerations e.g. RTCs

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

Question 6

what are the long term effects of trauma

Answer 6

• Effect on growth

- Psychological implications of a fracture

Question 7

What are the main causes for respiratory failure

Answer 7

1-Respiratory obstruction

• Birth asphyxia
• Croup
• Epiglottitis
• Foreign body inhalation
• Bronchiolitis
• Asthma
• Pneumothorax

2-Respiratory depression

• Poisoning
• Convulsions
• Raised intra-cranial pressure
  1. Head injury
  2. Acute encephalopathy
  a. Meningitis
  b. Encephalitis

Question 8

what are the main causes of circulatory failure

Answer 8

1-Fluid loss
Gastroenteritis
Burns
Trauma

2-Fluid maldistribution
Sepsis
Anaphylaxis
Heart failure

Question 9

what are the three peaks of death

Answer 9

First peak: Die at scene or instantaneously

Second peak: ABCDs problems

Third peak: Delayed death despite management

Question 10

What is the universal approach to ABCDS

Answer 10

catastrophic haemorrhage control
Airway with C-spine – remember O2!
Breathing with Ventilation
Circulation with Haemorrhage Control
Disability
Exposure/Environment
Don’t Ever Forget Glucose!

Question 11

What classification is used to classify fractures in the growth plate?

Answer 11

SALTER HARRIS CLASSIFICATION