Paediatric trauma Flashcards

(60 cards)

1
Q

Leading causes of unsuccessful resuscitation in paediatric patients with severe trauma

A

Failure to secure compromised airway
Failure to support breathing
Failure to recognise / respond to intra-abdominal and intracranial haemorrhage

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2
Q

WET FLAG acronym

A

Weight
Energy
Tube

Fluid bolus
Lorazepam
Adrenaline
Glucose

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3
Q

Weight from WET FLAG

A

ATLS formula = (Age + 5) x 2 kg
WET FLAG formula = (Age + 4) x 2 kg

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4
Q

Energy from WET FLAG

A

Weight x 4 Joules

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5
Q

Tube from WET FLAG

A

Internal diameter = (Age / 4) + 4 cm
Length (oral) = (Age / 2) + 12 cm
Length (nasal) = (Age / 2) + 15 cm

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6
Q

Fluids from WET FLAG

A

Bolus of fluid:

Medical = 20 ml/kg
Trauma = 10 ml/kg

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7
Q

Lorazepam from WET FLAG

A

0.1 mg/kg

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8
Q

Adrenaline from WET FLAG

A

0.1 ml/kg of 1:10,000

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9
Q

Glucose from WET FLAG

A

2 ml/kg of 10% Dextrose

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10
Q

Clinical decision tools in paediatric trauma patients

A

Field triage decision scheme

Paediatric trauma score

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11
Q

Role of clinical decision tools in paediatric trauma patients

A

For early identification of multi-system injuries and to guide transfer to higher level centres within trauma system

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12
Q

Estimated normal systolic BP calculation in paediatric patients

A

(Age x 2) + 90

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13
Q

Estimated lower range of normal systolic BP calculation in paediatric patients

A

(Age x 2) + 70

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14
Q

Estimated normal diastolic BP calculation in paediatric patients

A

2/3 systolic BP

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15
Q

HR in age 0-1 yrs

A

<160

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16
Q

BP in age 0-1 yrs

A

> 60

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17
Q

RR in age 0-1 yrs

A

<60

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18
Q

UO in age 0-1 yrs

A

2 ml/kg/hr

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19
Q

HR in age 1-2 yrs

A

< 150

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20
Q

BP in age 1-2 yrs

A

> 70

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21
Q

RR in age 1-2 yrs

A

< 40

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22
Q

UO in age 1-2 yrs

A

1.5 ml/kg/hr

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23
Q

HR in age 3-5 yrs

A

< 140

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24
Q

BP in age 3-5 yrs

A

> 75

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25
RR in age 3-5 yrs
< 35
26
UO in age 3-5 yrs
1 ml/kg/hr
27
HR in age 6-12 yrs
< 120
28
BP in age 6-12 yrs
> 80
29
RR in age 6-12 yrs
< 30
30
UO in age 6-12 yrs
1 ml/kg/hr
31
HR in age 13 yrs and older
< 100
32
BP in age 13 yrs and older
> 90
33
RR in age 13 yrs and older
< 30
34
UO in age 13 yrs and older
0.5 ml/kg/hr
35
Priorities for assessing and managing paediatric trauma
Same as adults ABCDE
36
Unique characteristics of paediatric trauma
Airway and breathing issues more common that circulatory compromise Increased heat loss
37
Cause for increased heat loss in paediatric patients
Higher surface area to volume ratio Higher metabolic rate than adults Less subcutaneous tissue than adults
38
Methods for estimating weight and drug doses for children
WET FLAG and WAtCH drugs Length based paediatric resuscitation tapes Ask parent
39
Anatomical differences in paediatric patient for airway assessment
Large occiput causes passive flexion of c spine Trachea is shorter for intubation
40
Changes to airway management of paediatric patient
Maintain plane of midface parallel to spine board in neutral position Achieved by placing cushion under entire torso of child, but not under head
41
Age by which cricothyroid membrane is usually palpable
By age 12 years and older
42
Common causes of deterioration / drop in sats of an intubated patient
DOPE
43
D of DOPE
Dislodgement of ET tube
44
O of DOPE
Obstruction Secretions of kinking Can try suctioning tube
45
P of DOPE
Pneumothorax Tension pneumothorax secondary to positive pressure in patients
46
E of DOPE
Equipment failure Failure of ventilators, pulse oximeter or oxygen delivery device
47
Most common acid-base abnormality in paediatric resuscitation
Respiratory acidosis due to hypoventilation Can be exacerbated by sodium bicarbonate in absence of adequate ventilation
48
Site of needle decompression of pneumothorax in children
Second intercostal space, midclavicular line NOT CHANGED IN CHILDREN unlike adults
49
Signs of hypovolaemia in children
Tachycardia Poor skin perfusion / mottling Narrow pulse pressure < 20 mmHg Child's increased physiologic reserve can maintain BP even in shock
50
Sudden change from tachycardia to bradycardia in infants
Severe distress and >40% blood loss Treat with rapid IV crystalloid + blood
51
Options for IV access in order of preference
1) Peripheral percutaneous max 2 attempts 2) IO 3) Femoral line 4) Internal jugular line 5) Venous cutdown saphenous vein at ankle - last resort
52
"Damage control resuscitation" definition
Restrictive use of crystalloid fluids and early administration of balanced ratios packed RBCs, platelets and FFP
53
Management of children with transient or no response to initial resuscitation
Further blood products Major haemorrhage protocol Consideration of early operative management
54
Situations where children receiving CPR are most likely non survivors
CPR > 15 mins Pupils fixed
55
Percentage likelihood of neurologically intact survival following ROSC after traumatic arrest and CPR in field
50%
56
Consideration in paediatric trauma with no fractures
May still have underlying organ injury as bones immature
57
Nasogastric tube or Orogastric tube preferred in paediatric patients
Orogastric tube
58
Change to CT guidance in paediatric trauma
Only scan area of interest
59
Paediatric GCS score - Verbal component
5 - appropriate words or social smile, fixes and follows 4 - cries but consolable 3 - persistently irritable 2 - Restless, agitated 1 - none
60
ABCDEs of injury prevention in non accidental injuries
Analyse injury data Build local coalitions Communicate the problem Develop prevention activities Evaluate the interventions