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Flashcards in approach to trauma in pediatric patient Deck (15):
1

pathophys

multisystem injury is the rule instead of exception. trauma induces a systemic neuroendocrine response resulting in the release of inflammatory mediators, causing hypo-volemia, hypotension, hypothermia, and hypo-oxygenation. Look for peripheral signs first (increased cap refill, cool skin) and then change in BP.

2

anatomic characteristics of children that lead to increased susceptibility to injury

-skeletal and ligamentous structures have increased flexibility, which results in greater transmission of force to internal organs.
-weak neck muscles and higher center of gravity lead to more head injuries
-less protective muscle and subcu tissue over internal organs means viscera are closer to the surface and can be bruised

3

physiologic characteristics of children that lead to increased susceptibility to injury

-underlying heart disease rarely results in morbidity in children.
-hypoxia and respiratory failure are increasingly likely in children
-high body surface area to weigh ratio predisposes children to hypothermia, which may complicate shock and worsen acidosis if its not corrected.

4

what to give iv

isotonic fulid, NS or ringers, at 20 ml/kg up to 80 ml/kg after that consider blood or other crystalloid. after initial bolus if stable start fluid replacement 100 ml/kg for first 10 kg, 50 ml/kg for next 10 kg, and 20 ml/mg for each kg over 20. 40 or more kg get adult fluid maintenance of 2000 ml over 24 hours.

5

radiology

c-spine, chest and pelvis first.

6

causes of abdominal trauma

falls, bike accident, seatbelt, kick etc

7

symptoms of abdominal trauma

diffuse abdominal pain, vomitting, distention, sudden collapse if splenic injury

8

exam for abdominal trauma

peritoneal signs, decreased bowel sounds, rigid abdomen, melena, look for bruising along the seat belt or tire tracks

9

management of abdominal trauma

order plain film, may see air/fluid level in loops of bowel, hematoma shadow, splenic shadow or narrowing of lumen in bowel.

10

c-spine trauma

to stabalize, may need to roll under shoulders and pad under head to place head in neutral position. most commonin infants and children is C1, C1/C2 or C5-C7 in school age (>8 same guidelines as adult).

11

symptoms of Head/Cspine injury

vomiting, irritability, headache, visual changes, amnesia, altered level of consciousness, seizures, superficial contusion, all the way to respiratory arrest

12

Exam for head/cspine injury

full exam including neurological and fundiscopic (can see retianl hemorrhages). Neuro exam may reveal altered level of cosciousness, alterations in tone or focal abnormalities.

13

grade 1 head injury

transient confusion, No LOC, post traum. amnesia

14

grade 2 injury

transient confusion No LOC, post traum amnesia > 15 miin

15

grade 3 injury

continued confusion, any LOC, post traum amnesia >12 hours