Major Trauma (Paed) CPG Notes Flashcards
(22 cards)
What are the five main care objectives for paediatric trauma management?
- Immediate control of major haemorrhage
- Ensure airway patency
- Ensure adequate oxygenation and ventilation
- Ensure adequate perfusion
- Prioritise transport
- Provide supportive care as required
These objectives guide the management of traumatic injuries in children.
Who is this guideline intended for?
Patients aged under 16 with traumatic injuries.
The guidelines specifically address the needs of paediatric patients.
Is this CPG only for major trauma patients?
No, it’s primarily intended for major trauma, but principles apply to minor trauma too.
The guidelines emphasize the application of trauma principles across varying severities.
When should treatment be delayed to obtain IV access in shocked patients?
Never. Transport should not be delayed for IV access in shocked paediatric patients.
Prompt transport is critical in cases of shock.
What is the priority in penetrating truncal trauma?
Rapid transport with only immediately life-threatening conditions treated first.
This approach minimizes time spent on scene.
What is the first priority in paediatric trauma management?
Major haemorrhage control.
Control of bleeding is vital to prevent further complications.
Why is regular reassessment of haemorrhage control essential?
Because control can fail over time due to dislodged dressings, splints, or rising BP.
Continuous monitoring is necessary to ensure effective management.
When should OPAs be avoided in paediatric trauma?
If they provoke gag reflex or if other airway techniques are effective.
Proper airway management is critical in trauma situations.
What oxygen therapy is recommended?
NRBM at 10–15 L/min for major trauma; titrate to SpO₂ > 95% if stable.
This ensures adequate oxygenation in critically injured patients.
When should oxygen be titrated down?
Once the patient is stable, SpO₂ is reliable, and other care is addressed.
Adjusting oxygen levels prevents unnecessary overdose.
What other condition should be considered in breathing assessment?
Chest injury – assess need for decompression (CPG P0802).
Addressing chest injuries promptly can be life-saving.
Is permissive hypotension appropriate in children?
No. It is not recommended due to risk of impending cardiac arrest.
Managing blood pressure in children is crucial to prevent severe outcomes.
What are reliable signs of adequate perfusion in children?
- Radial pulse
- Central cap refill < 3 sec
- Normal mental status
These indicators help assess the child’s circulatory status.
When is fluid resuscitation appropriate?
If any signs of shock: tachycardia, hypotension, prolonged CRT, AMS, or no radial pulse.
Early fluid resuscitation can stabilize a patient in shock.
Who can administer PRBC in the field?
Credentialed MICA paramedics.
Only trained personnel are authorized to perform this task.
What are the two conditions for administering PRBC to minors?
- Parent/legal guardian contacted and does not object
- Medical doctor approves (preferably AV Medical Advisor or RCH)
Ensuring parental consent and medical oversight is critical for ethical practice.
Should you wait for PRBC before transporting?
No. Do not delay scene time waiting for PRBC.
Timely transport is essential in trauma care.
What measures should be taken to warm a child with trauma?
- Use ambulance heater
- Remove wet clothing
- Dry patient
- Apply blankets and cover head
- Use warming blankets only if shocked/intubated/hypothermic
- Use blood/fluid warmer if available
Maintaining body temperature is crucial for recovery.
Why is hypothermia prevention important?
It’s an independent predictor of mortality and worsens coagulopathy.
Hypothermia can severely complicate trauma care.
When should spinal immobilisation be considered?
As per CPG P0804 Spinal Injury.
Guidelines provide specific criteria for spinal injury management.
When should a cervical collar be applied if intubation is required?
After intubation.
Proper sequence in airway management is important.
What additional measure supports venous drainage in TBI or chest injury?
Raise head of stretcher by 10–15 degrees.
This position can aid in reducing intracranial pressure.
