Paediatric trauma

Question 1

Leading causes of unsuccessful resuscitation in paediatric patients with severe trauma

Answer 1

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

Question 2

WET FLAG acronym

Answer 2

Weight
Energy
Tube

Fluid bolus
Lorazepam
Adrenaline
Glucose

Question 3

Weight from WET FLAG

Answer 3

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

Question 4

Energy from WET FLAG

Answer 4

Weight x 4 Joules

Question 5

Tube from WET FLAG

Answer 5

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

Question 6

Fluids from WET FLAG

Answer 6

Bolus of fluid:

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

Question 7

Lorazepam from WET FLAG

Answer 7

0.1 mg/kg

Question 8

Adrenaline from WET FLAG

Answer 8

0.1 ml/kg of 1:10,000

Question 9

Glucose from WET FLAG

Answer 9

2 ml/kg of 10% Dextrose

Question 10

Clinical decision tools in paediatric trauma patients

Answer 10

Field triage decision scheme

Paediatric trauma score

Question 11

Role of clinical decision tools in paediatric trauma patients

Answer 11

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

Question 12

Estimated normal systolic BP calculation in paediatric patients

Answer 12

(Age x 2) + 90

Question 13

Estimated lower range of normal systolic BP calculation in paediatric patients

Answer 13

(Age x 2) + 70

Question 14

Estimated normal diastolic BP calculation in paediatric patients

Answer 14

2/3 systolic BP

Question 15

HR in age 0-1 yrs

Answer 15

<160

Question 16

BP in age 0-1 yrs

Answer 16

> 60

Question 17

RR in age 0-1 yrs

Answer 17

<60

Question 18

UO in age 0-1 yrs

Answer 18

2 ml/kg/hr

Question 19

HR in age 1-2 yrs

Answer 19

< 150

Question 20

BP in age 1-2 yrs

Answer 20

> 70

Question 21

RR in age 1-2 yrs

Answer 21

< 40

Question 22

UO in age 1-2 yrs

Answer 22

1.5 ml/kg/hr

Question 23

HR in age 3-5 yrs

Answer 23

< 140

Question 24

BP in age 3-5 yrs

Answer 24

> 75

Question 25

RR in age 3-5 yrs

Answer 25

< 35

Question 26

UO in age 3-5 yrs

Answer 26

1 ml/kg/hr

Question 27

HR in age 6-12 yrs

Answer 27

< 120

Question 28

BP in age 6-12 yrs

Answer 28

> 80

Question 29

RR in age 6-12 yrs

Answer 29

< 30

Question 30

UO in age 6-12 yrs

Answer 30

1 ml/kg/hr

Question 31

HR in age 13 yrs and older

Answer 31

< 100

Question 32

BP in age 13 yrs and older

Answer 32

> 90

Question 33

RR in age 13 yrs and older

Answer 33

< 30

Question 34

UO in age 13 yrs and older

Answer 34

0.5 ml/kg/hr

Question 35

Priorities for assessing and managing paediatric trauma

Answer 35

Same as adults ABCDE

Question 36

Unique characteristics of paediatric trauma

Answer 36

Airway and breathing issues more common that circulatory compromise Increased heat loss

Question 37

Cause for increased heat loss in paediatric patients

Answer 37

Higher surface area to volume ratio Higher metabolic rate than adults Less subcutaneous tissue than adults

Question 38

Methods for estimating weight and drug doses for children

Answer 38

WET FLAG and WAtCH drugs Length based paediatric resuscitation tapes Ask parent

Question 39

Anatomical differences in paediatric patient for airway assessment

Answer 39

Large occiput causes passive flexion of c spine Trachea is shorter for intubation

Question 40

Changes to airway management of paediatric patient

Answer 40

Maintain plane of midface parallel to spine board in neutral position Achieved by placing cushion under entire torso of child, but not under head

Question 41

Age by which cricothyroid membrane is usually palpable

Answer 41

By age 12 years and older

Question 42

Common causes of deterioration / drop in sats of an intubated patient

Answer 42

DOPE

Question 43

D of DOPE

Answer 43

Dislodgement of ET tube

Question 44

O of DOPE

Answer 44

Obstruction Secretions of kinking Can try suctioning tube

Question 45

P of DOPE

Answer 45

Pneumothorax Tension pneumothorax secondary to positive pressure in patients

Question 46

E of DOPE

Answer 46

Equipment failure Failure of ventilators, pulse oximeter or oxygen delivery device

Question 47

Most common acid-base abnormality in paediatric resuscitation

Answer 47

Respiratory acidosis due to hypoventilation Can be exacerbated by sodium bicarbonate in absence of adequate ventilation

Question 48

Site of needle decompression of pneumothorax in children

Answer 48

Second intercostal space, midclavicular line NOT CHANGED IN CHILDREN unlike adults

Question 49

Signs of hypovolaemia in children

Answer 49

Tachycardia Poor skin perfusion / mottling Narrow pulse pressure < 20 mmHg Child's increased physiologic reserve can maintain BP even in shock

Question 50

Sudden change from tachycardia to bradycardia in infants

Answer 50

Severe distress and >40% blood loss Treat with rapid IV crystalloid + blood

Question 51

Options for IV access in order of preference

Answer 51

1) Peripheral percutaneous max 2 attempts 2) IO 3) Femoral line 4) Internal jugular line 5) Venous cutdown saphenous vein at ankle - last resort

Question 52

"Damage control resuscitation" definition

Answer 52

Restrictive use of crystalloid fluids and early administration of balanced ratios packed RBCs, platelets and FFP

Question 53

Management of children with transient or no response to initial resuscitation

Answer 53

Further blood products Major haemorrhage protocol Consideration of early operative management

Question 54

Situations where children receiving CPR are most likely non survivors

Answer 54

CPR > 15 mins Pupils fixed

Question 55

Percentage likelihood of neurologically intact survival following ROSC after traumatic arrest and CPR in field

Answer 55

50%

Question 56

Consideration in paediatric trauma with no fractures

Answer 56

May still have underlying organ injury as bones immature

Question 57

Nasogastric tube or Orogastric tube preferred in paediatric patients

Answer 57

Orogastric tube

Question 58

Change to CT guidance in paediatric trauma

Answer 58

Only scan area of interest

Question 59

Paediatric GCS score - Verbal component

Answer 59

5 - appropriate words or social smile, fixes and follows 4 - cries but consolable 3 - persistently irritable 2 - Restless, agitated 1 - none

Question 60

ABCDEs of injury prevention in non accidental injuries

Answer 60

Analyse injury data Build local coalitions Communicate the problem Develop prevention activities Evaluate the interventions