Peadiatric Trauma

Question 1

Where are common bleeding sites for paediatric trauma?

Answer 1

Chest, Abdo, pelvis, long bones, head and scalp

Question 2

What blood type product should be given to paediatric trauma patients?

Answer 2

O neg

Question 3

What is the dose for PRBC for a paediatric trauma patient?

Answer 3

10-20ml/kg

Question 4

What can you use to manage hypothermic patients?

Answer 4

Warmed product administration
Forced air warmers
Control environment temp

Question 5

What do you need to look out for is a patient is treated with a massive transfusion?

Answer 5

Hypocalcaemia as blood is treated with citrate

Question 6

Due to the rarity of major trauma in children, what needs to be taken into consideration?

Answer 6

Human factors and Crew Resource Management

Question 7

What is the leading cause of death in children more than 1 year of age?

Answer 7

Neuro trauma - disability is common with a profound impact on functional long term outcomes

Question 8

Why are children more susceptible to TBIs?

Answer 8

They have a larger head to body size ratio
Thinner cranial bones
Less myelinated neural tissue
Greater incidence of DAI and cerebral oedema

Question 9

How quickly should a head CT be obtained within?

Answer 9

30 minutes of arrival

Question 10

If getting a CT head on a child proves to be challenging, especially when they are distressed. What could the trauma team decide?

Answer 10

Whether sedation and/or intubation is necessary

Question 11

What is the criteria for a head CT in a paediatric trauma patient?

Answer 11

Initial assessment of a GCS less than 14/ 15 for children under 1 year
Suspected open or depressed skull fracture
Tense fontanelle
Any signs of a basal skull fracture
Focal neurological deficit for children under 1 years
Presence of bruise, swelling or laceration of more that 5 cm on the head
Witnessed LOC more than 5 mins
Abnormal drowsiness
3 or more episodes of vomiting
Significant mechanism of injury
Amnesia lasting more than 5 mins

Question 12

What should happen to a child who has sustained a head injury and only has 1 of the risk factors?

Answer 12

They should be observed for a minimum of 4 hours after the injury. If they develop and of the risk factors during that time they should have a head CT within an hour. If none of the above it’s clinical judgment as to whether they can be discharged

Question 13

When discharging paediatric patients home, what needs to be considered?

Answer 13

Their home social situations

Question 14

What is the criteria for admitting a child with a head injury?

Answer 14

-CT findings suggesting fractures, contusions or intra-cerebral bleed
-Signs of neurological dysfunction
-Severe headache or vomiting
-Presence of serious clotting disorders
-Difficult social conditions at home, unable to re-present quickly or a lack of a responsible adult to carry out observations after discharge

Question 15

What is the result of drowning?

Answer 15

Primary respiratory impairment from submersion/immersion in a liquid medium

Question 16

What is one of the leading causes of paediatric death globally?

Answer 16

Drowning

Question 17

What are some of the factors that influence the risk of drowning during childhood?

Answer 17

Socio-economic factors
Swimming ability
Substance misuse
Pre-existing co-morbidities

Question 18

What is common following drowning and may adversely affect resuscitation?

Answer 18

Hypothermia

Question 19

What are common at temps below 30 degrees?

Answer 19

Arrhythmias and some may be refractory at these temps

Question 20

How should arrhythmias, such as VF, be treated in a hypothermic (below 30 degrees)drowning paeds patient?

Answer 20

Defibrillation should be limited to 3 shocks and inotropic or anti arrhythmia drugs should not be given. If the 3 shocks are unsuccessful the patient should be rewarded to above 30 degrees where further defibrillation should be attempted

Question 21

Should the dose interval for resuscitation drugs be doubled or halved between temps of 30-35 degrees?

Answer 21

Doubled

Question 22

At what core temperature should resuscitation be continued to, especially if it can’t be raised further despite active measures?

Answer 22

32 Degrees

Question 23

What are core rewarming techniques?

Answer 23

IV fluids
Warm ventilator gases
Gastric or bladder lavage
Peritoneal lavage
Pleural or pericardial lavage
Endovascular rewarming
Extracorporeal rewarming

Question 24

What are external rewarming techniques?

Answer 24

Remove wet clothing
Supply warm blankets
Forced warm air system
Heating blankets

Question 25

How much should a patients temperature rise per hour to reduce haemodynamic instability?

Answer 25

No more than 0.5 degrees

Question 26

What happens in the body during active rewarming?

Answer 26

Vasodilation which the results in hypotension

Question 27

How should hypotension by managed in patients with active rewarming?

Answer 27

Having warmed IV fluids

Question 28

What organ is most at risk following asphyxiation?

Answer 28

The brain

Question 29

What happens first after submersion, cardiac problems or cerebral impairment?

Answer 29

Cerebral impairment

Question 30

What is the clinical course of a patient following drowning determined by?

Answer 30

Duration of hypoxic-ischemic time and the adequacy of resuscitation

Question 31

What are the prognostic indicators in drowning for a poor outcome?

Answer 31

Immersion time -greater than 10 mins
Time to first respiratory effort - after 3 mins
Core temp - less than 33 degrees on arrival and water temp below 10
Persisting coma - less than 5
Arterial pH - remains below 7.1
Arterial PO2 - remains below 8.0 kPa

Question 32

What is the most prevalent cause of trauma in children under 1 year old?

Answer 32

Non-accidental injury

Question 33

When assessing a child what factors do you need to be aware of that could raise concerns for a non-accidental injury?

Answer 33

• trauma without a significant mechanism of injury
• trauma in a pre-mobile child
• excessive bruising and pattern of bruising
• cigarette burns
• bite marks
• injuries to inaccessible areas (neck, ears, hands, feet, buttocks)
• intra-oral trauma (damage to frenulum)
• genital/anal trauma where no clear history of direct trauma is offered

Question 34

Why is it important to get a birth history in children under 1 years old?

Answer 34

Traumatic birth injury can be a reason for limb fractures and fractured clavicles in the neonate. This can be clarified by a precise history and observing the calcification around the fracture site

Question 35

When there are concerns around the presentation of a paediatric trauma patient, who should be contacted?

Answer 35

On-call safeguarding team

Question 36

What is the priority when looking after a paediatric trauma patient?

Answer 36

To act in the best interest of the child, the child’s rights to be protected, respect the rights of the child in terms of confidentiality