Injured Child

Question 1

What is a greenstick fracture?

Answer 1

Fracture in which the bone bends and breaks

Question 2

What type of injury is Salter Harris classification used for?

Answer 2

Growth plate injuries

Question 3

What types of injuries may children sustain?

Answer 3

• Fracture
• Wounds
• Burns + Scalds
• Head injuries
• Drowning

Question 4

In what ways may size affect injury in children?

Answer 4

• Smaller target (More energy absorbed for same impact)
• Large surface area:volume ratio
• Relatively large head
• Smaller mass (Drug doses etc differ)

Question 5

What other anatomical differences may affect injury in children?

Answer 5

Skeleton
-Incompletely calcified
-Provides less protection for vital organs
Inside
-Less elastic connective tissue
-Crowding of organs

Question 6

What other metabolism differences may affect injury in children?

Answer 6

• Thermoregulation differences

- Hypoglycaemia (Little glycogen in the liver)

Question 7

What is SCIWORA?

Answer 7

-Spinal cord injury without radiological abnormality

Question 8

In what way may psychology affect trauma presnetation?

Answer 8

• Communication difficulties
• Fear affects vital signs
• Distressed parents
• Effects on staff

Question 9

For a child under 1, what is normal RR?

Answer 9

30-40

Question 10

For a child under 1, what is normal Systolic BP?

Answer 10

70-90

Question 11

For a child under 1, what is normal HR?

Answer 11

110-160

Question 12

What are some potential causes for life-threatening respiratory obstruction leading to respiratory failure?

Answer 12

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

Question 13

What are some potential causes for life-threatening respiratory depression leading to respiratory failure?

Answer 13

• Poisoning
• Convulsions
• Raised ICP (Head injury, acute encephalopathy)

Question 14

What are some potential causes for life-threatening circulatory failure?

Answer 14

Fluid loss
-Gastroenteritis
-Burns
-Trauma
Fluid Maldistribution
-Sepsis
-Anaphylaxis
-Heart failure

Question 15

When does the first peak of death in trauma occur?

Answer 15

Dying instantly/at the scene

-Unsurvivable major vessel + brain injury

Question 16

When does the second peak of death in trauma occur?

Answer 16

Death from significant ABCD problems unless adequately resuscitated

Question 17

What is the aim of trauma resuscitation?

Answer 17

To restore normal tissue oxygenation as quickly as possible

Question 18

What are the steps involved in primary survey?

Answer 18

• 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 19

What is the rough estimation for weight in a child under 1 year?

Answer 19

(0.5 x Age in months) +4

Question 20

What is the rough estimation for weight in a child between 1-5yr?

Answer 20

(2x age) +8

Question 21

When does the third peak of death in trauma occur?

Answer 21

Delayed deaths despite resuscitation, surgery and intensive care

• Multi-organ failure
• Sepsis

Question 22

List some airway differences in children?

Answer 22

• Large head to body size
• Short necks
• Large tongue
• Obligate nasal breathers
• Nasal passages easily obstructed
• Compressible floor of mouth and trachea
• High anterior larynx

Question 23

List some breathing differences in children?

Answer 23

• Small total surface area for air tissue interface
• Lower airways small- easily obstructed
• Diaphragmatic breathing
• Fewer type I (slow twitch) fibres- easy fatigue
• Soft non-calcified bones- v. compliant chest wall- recession and in-drawing
• Horizontal ribs- less expansion

Question 24

What happens to systemic vascular resistance with age?

Answer 24

Increases