Approach to the injured child.

Question 1

What is the leading cause of death in children 1-19 years old in the United States?

Answer 1

Injury (this accounts for 50% of all childhood deaths)

Question 2

What proportion of ED visits of children younger than 15 years are as a result of injuries?

Answer 2

One third

Question 3

what is the most common cause of injury related death?

Answer 3

Motor vehicle crashes.

Question 4

What is the most common cause of death in Black teenagers?

Answer 4

Homicide from firearms.

Question 5

What percentage of motor vehicle fatalities are secondary to pediatric pedestrian injuries?

Answer 5

46%.

Question 6

True or false: 40% of children experience penetrating injury as the mechanism of major injury

Answer 6

False; only 10-20% experience penetrating injury. Blunt trauma is the predominant mechanism of major injury in children.

Question 7

What is the main cause of trauma mortality in children and what is the main cause of preventable death in traumas?

Answer 7

Brain injury is responsible for 80% of trauma mortality. Failure to secure the airway is the most common cause of preventable death

Question 8

How would you define multiple trauma?

Answer 8

Apparent injury to 2 or more body areas of any severity.

Question 9

What can make distinguishing isolated or multiple traumas challenging?

Answer 9

Serious injuries can of over time, children may be difficult to examine due to developmental stage, the injury may be intentional some mechanism a unclear, drugs or alcohol exposure may coexist

Question 10

What is a difference between a trauma score (TS) and revised trauma score (RTS)?

Answer 10

Trauma score requires evaluation of capillary refill in respiratory effort which can be difficult to evaluate at night. The revised trauma score removes these 2 variables

Question 11

True or false: the pediatric trauma scale (PTS) is a poor predictor of mortality.

Answer 11

False, a PTS of greater than 8 is associated with 9% mortality while a PTS of less than zero is associated with 100% mortality. There is a linear relationship between lower PTS and increased potential for mortality. Note solid organ injury in children may present with a normal PTS

Question 12

True or false: All patients with major trauma do not necessarily need to receive supplemental oxygen.

Answer 12

False

Question 13

What is the most appropriate choice of surgical airway in children younger than 8 years old?

Answer 13

Needle cricothyrotomy

Question 14

What systolic blood pressure does a palpable peripheral pulse normally correlate with?

Answer 14

80 mmHg

Question 15

If there are absent peripheral pulses but palpable central pulses what systolic blood pressure does this correlate with?

Answer 15

Systolic blood pressure greater than 50-60 mmHg

Question 16

True or false: External hemorrhage should be controlled by an extremity tourniquet to stop the bleeding in pediatric patients.

Answer 16

False: External hemorrhage should be controlled by direct pressure or pneumatic splints. Application of an extremity tourniquet, although more common in adult trauma remains to be evaluated in children.

Question 17

What is the percentage blood loss estimated if there is shock after major trauma?

Answer 17

40%

Question 18

Define class I hemorrhage.

Answer 18

Estimated loss of 15% (up to 250 mL circular 20 kg child); minimal physiological changes

Question 19

Define class II hemorrhage

Answer 19

Estimated blood loss of 15-30% (250-500 mL’s loss in a 20 kg child). Often associated with tachycardia and tachypnea and fall impulse pressure

Question 20

Define class III hemorrhage

Answer 20

Estimated blood loss of 30-40% (500-650 mL of blood loss in 20 kg child). This is often associated with altered mental status tachycardia, tachypnea and measurable fallen systolic blood pressure. Most patients will require blood products.

Question 21

Define class IV hemorrhage

Answer 21

Estimated blood loss was 40%. This is immediately life-threatening. Associated with depressed mental status, cold pale profound tachycardia tachypnea and now her pulse pressure. Immediate transfusion is warranted.

Question 22

True or false: Cardiac tapenade and tension pneumothorax can cause dilated neck veins.

Answer 22

True

Question 23

What are the characteristics of neurogenic shock?

Answer 23

Classically neurogenic shock causes hypotension without tachycardia or vasoconstriction.

Question 24

How much crystalloid is indicated depending on blood loss?

Answer 24

The patient usually requires 300 mL’s of crystalloid for each 100 mL’s blood loss

Question 25

What is the physiological target of urine output in children greater than a year old?

Answer 25

1 mL per kilo per hour

Question 26

what is the physiological target of urine output in children less than a year old

Answer 26

2 mL’s per kilo per hour

Question 27

True or false: vasopressors, steroids, sodium bicarbonate do have a role in the initial treatment of hypovolemic shock

Answer 27

False

Question 28

What is the ratio of FFP to packed RBCs in massive transfusion situations and adults?

Answer 28

1:1 leads to best survival

Question 29

When his urinary catheterization and a trauma not indicated?

Answer 29

Do not attempt if urethral integrity is questionable based on blood at the urethral meatus or in the scrotum or if there is abnormal prostate placement on rectal examination

Question 30

What are high-risk mechanisms for C-spine injury in young children

Answer 30

Fall from more than or equal to 1 floor, Pedestrian versus motor vehicle at 30 mph or more an unrestrained a poorly restrained occupants of a motor vehicle involved in a significant crash.

Question 31

Why does SCIWORA occur in children

Answer 31

This is due to ligamentous laxity and incomplete development of the bony spine.

Question 32

When is a CT of the neck indicated in a child who has a serious injury

Answer 32

if an endotracheal tube was placed CT scan of C1 and C2 during CT head imaging replaces the need for odontoid view

Question 33

true or false: A helmeted injury patient’s can undergo an initial cervical spine radiographic series before helmeted removal

Answer 33

true

Question 34

Muffled heart sounds, distended neck veins and narrow pulse pressure should prompt which procedure in a trauma patient?

Answer 34

Pericardiocentesis to relieve cardiac tamponade

Question 35

What chest radiograph abnormalities would suggest a thoracic aortic injury? What further imaging is indicated?

Answer 35

Widened mediastinum with or without fractured first rib. In this case a CT angiogram is promptly indicated