approach to trauma in pediatric patient Flashcards Preview

Pediatrics > approach to trauma in pediatric patient > Flashcards

Flashcards in approach to trauma in pediatric patient Deck (15)
Loading flashcards...
1
Q

pathophys

A

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
Q

anatomic characteristics of children that lead to increased susceptibility to injury

A
  • 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
Q

physiologic characteristics of children that lead to increased susceptibility to injury

A
  • 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
Q

what to give iv

A

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
Q

radiology

A

c-spine, chest and pelvis first.

6
Q

causes of abdominal trauma

A

falls, bike accident, seatbelt, kick etc

7
Q

symptoms of abdominal trauma

A

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

8
Q

exam for abdominal trauma

A

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

9
Q

management of abdominal trauma

A

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

10
Q

c-spine trauma

A

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
Q

symptoms of Head/Cspine injury

A

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

12
Q

Exam for head/cspine injury

A

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
Q

grade 1 head injury

A

transient confusion, No LOC, post traum. amnesia

14
Q

grade 2 injury

A

transient confusion No LOC, post traum amnesia > 15 miin

15
Q

grade 3 injury

A

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