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ATLS-pediatric trauma Flashcards

(47 cards)

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1
Q

Why is it that multisystem trauma is the rule rather than the exception in children?

A

Small stature and physical characteristics

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2
Q

Why are bone fractures in children more significant than the same in an adult?

A

bones are much more pliable, and thus more energy was required

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3
Q

Why are thermal issues more severe in children?

A

Higher body surface area to volume

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4
Q

What are the four clinical criteria to justify the use of radiation in children?

A
  • Information cannot be obtained another way
  • Info will change clinical management
  • Obtained at lowest radiation
  • will not delay care
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5
Q

How do you determine the appropriate dosages and equipment sizes for children?

A

Use the broselow tape

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6
Q

How do you maintain inline stabilization for infants and children? Why this way?

A

midface should be aligned with the backboard

Occiput is relatively larger in chldren

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7
Q

What is the equation for determining the proper ET tube depth?

A

3x the tube size gives the length in cm

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8
Q

Why should you not insert an oropharyngeal airway and rotate 180 degrees in children?

A

Soft palate is much more delicate

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9
Q

What part of the airway is the smallest in children?

A

cricoid ring

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10
Q

How do you determine the correct radius of the ET tube for children?

A

Compare to pinky

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11
Q

What effect on the heart does intubation have? What happens this this effect in children?

A

Stimulation of the airway increases vagal tone, which is increased in children

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12
Q

What is the most common cause of bradycardia/arrest in children?

A

Hypoxia

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13
Q

Who may need pretreatment with atropine prior to intubation?

A

Infants to prevent vagal tone increase

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14
Q

What is the dose of etomidate in children? (normo and hypovolemic)

A
  1. 3 mg/kg if normovolemia

0. 1 if hypovolemic

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15
Q

What is the dose of succ in children? (2)

A

2 mg/kg if less than 10 kg,

1 mg/kg if over

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16
Q

Should nasotracheal intubation be used in children? Explain.

A

No, because will damage tissue and be harder d/t more anterior airway

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17
Q

What are the components of the DOPE mnemonic for common causes of deterioration in intubated patients?

A

Dislodgement
Obstruction
PTX
Equipment failure

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18
Q

How easy is it to dislodge an ET tube in a child? What is the significance of this?

A

Very easy, so reassess frequently, especially after moving patient

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19
Q

What is the alternative to intubation in an infant or small child?

Study These Flashcards
A

Needle cricothyroidotomy

20
Q

The use of a pediatric bag-valve mask is indicated for children under what weight (in kg)?

21
Q

What is the most common cause of acidosis in a ventilated child?

Study These Flashcards
A

Inadequate ventilation

22
Q

Where is the site for a chest tube in children? Needle decompression?

Study These Flashcards
A

Chest Tube = Same as for adults

Needle = 3rd intercostal midclavicular

23
Q

SBP is maintained until very late in pediatric shock. What, then, are the sign used to detect shock?

Study These Flashcards
A

tachycardia and poor peripheral perfusion

Narrow pulse pressure

24
Q

What is the substitute for clammy skin in kids?

Study These Flashcards
A

Skin mottling

25
What is the equation for mean SBP in children? Mean DBP?
``` SBP = 90 +2*(age in years) DBP = 70+2*(age in years) ```
26
What can be used to estimate a child's weight? (3)
- Ask caregiver - Broselow tape - (2*age)+10
27
How much blood does an infant have to lose to manifest hypotension?
30-45%
28
What is the next best thing to IV in the AC for children?
IO in the leg
29
Can you use an IO in a bone with a fracture?
No
30
What is the bolus rate for fluids and blood respectively in children?
``` Fluids = 20 ml/kg Blood = 10 ml/kg ```
31
Why are children more prone to developing a tension PTX?
Increased mobility of the mediastinum
32
True or false: pneumomediastinum is generally benign
True
33
Why is gastric distention of the abdomen common in children and what can be done to relieve this for an adequate exam?
Crying causes air swallowing | OG tube
34
Which is preferred in children: NG or OG tube?
OG
35
Why should the bladder be fully decompressed prior to evaluating the abdomen?
If full, may elicit discomfort and confuse exam findings
36
Can a FAST exam detect solid organ injury
no
37
True or false: + blood on a DPL in a child will lead immediately to an operative intervention
False--much more dependent on clinical status of the patient
38
Why should only the surgeon who is to operate on a child be the one to perform a DPL?
Because it may interfere with subsequent abdominal examinations
39
What is unique about the skull and thus cranial injuries in children?
Sutures are not fused, so can hold more blood or masses. Thus bulging fontanelles need to be addressed
40
True or false: all seizure activity in trauma patients require a head CTq
True
41
What is the significance of vomiting after head injury in children?
1 time, no big deal. But if persistent, then evaulate
42
When is neurosurgical consultation necessary in children, besides CT scan findings? (2)
- GCS less than 8 or motor scores of less than 2 | - Multiple injuries associated with head injury with hemodynamic instabilities
43
What are the scores and meaning for the verbal part of the pediatric GCS?
``` 5 = appropriate words or social smile, fixes and follows 4 = Cries, but unconsolable 3 = Persistently irritable 2 = restless, agitated 1 = none ```
44
What is and how common is pseudosubluxation in children?
The appearance of subluxing vertebral bodies (cervical) that can be normally present in in up to 40% of children
45
How can you differentiate true subluxation from pseudosubluxation in a child?
Have the child lie on a 1 inch thick mat beneath their entire body except the head. True subluxation will not disappear with this maneuver, and warrants more testing
46
How common are “spinal cord injury without radiographic abnormalities” (SCIWORA) in children compared to adults?
More
47
How much blood is lost in bone fractures in children compared to adults?
Less--should search for other causes of hemodynamic instability

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