Pediatric Trauma

Question 1

when do you take C-spine precauctions in peds?

Answer 1

GCS<13

Dangerous MOI

neck pain

Altered mental status

intoxication

Question 2

when do pediatric vitals look like adult vitals?

Answer 2

in children > 12 years old

Question 3

how much blood loss can a child sustain and still be in compensated shock?

Answer 3

45%

Question 4

what is the verbal GCS scoring for nonverbal pediatric patients?

Answer 4

coos, babbles 5

irritable cry 4

cries to pain 3

moans to pain 2

no response 1

Question 5

what problem is common in pediatric trauma patients that warrants intervention with a gastric tube?

Answer 5

gastroparesis

Question 6

what labs do you want to order for a peds trauma patient?

Answer 6

CBC, CMP, UA, Utox, blood glucose

Question 7

what’s the first part of the secondary survey in peds trauma?

Answer 7

A - allergies

M - medications

P - PMH, pregnancy

L - last meal

E- events/environment leading to injury

AMPLE

Question 8

If asystole persists after what is the prognosis poor in a pediatric resuscitation patient?

Answer 8

after two rounds of IV epinephrine OR

25 minutes of CPR without ROSC

Question 9

how is drowning defined and how is near drowning defined?

Answer 9

drowning is death within 24 hours of submersion or immersion in a liquid medium

near drowning is survival > 24 hours from the event

Question 10

what is the most common cause of death in children 1-4

Answer 10

drowning

Question 11

what is the most common cause of death in children older than 4?

Answer 11

MVCs

Question 12

why is hypothermia more of a problem in children?

Answer 12

high suface area: mass

decreased subcutaneous fat

limited thermogenic capacity

Question 13

moderate hypothermia (32-35) leads to what key metabolic change?

Answer 13

increase in 02 consumption

Question 14

severe hypothermia (<32) leads to what metabolic changes?

Answer 14

decreases cellular metabolic rate —> inadequate perfusion, hypotension, shock

7% decrease for every 1 degree C

*hypo/hyperglycemia, platelet dysfunction, depressed immune function

Question 15

Are c-spine precautions routinely recommended in pediatric drowning or near drowning?

Answer 15

No - only if separate indiction

Question 16

what else can you do in drowning other than O2?

Answer 16

CPAP or BiPAP

intubate if neurologic deterioration or PaO2<60mmHg or Sp02<90% w/o2

or PaCO2>50mmHg

Question 17

You have just discovered your near-drowning peds patient has a glucose of 15. What do you do?

Answer 17

D5

(some places D10)

Question 18

If hypothermia occurred first before asphyxia, pediatric patients generally have a better or worse prognosis?

Answer 18

better than if the asphyxia preceded the hypothermia

Question 19

After you have dried a near-drowning patient and removed their wet clothing, what else can you do to warm them?

Answer 19

external rewarming: blankets, heating pads, radiant heat, forced warm air

internal core rewarming with IV fluids (40-43)

humidified oxygen 42-46 degress via tracheal tube

continue until core reaches 32-35 degrees

Question 20

what is afterdrop?

Answer 20

the initial drop in temperature you see during initial warming in hypothermia

Question 21

how long does it take for hypoxemia to result in irreversible CNS injury in peds?

Answer 21

3-5 minutes

Question 22

you have a young girl that was resuscitated by EMS after she fell in her family swimming pool and was submerged after losing consciousness for 2 minutes. what do you do with her?

Answer 22

admit her and observe her

if she is asymptomatic for 8 hours, she can go home

(75% develop symptoms in first 8 hours)

Question 23

what is the most common foreign body ingestion in children?

Answer 23

coins

Question 24

when should you suspect toxic exposure/ingestion in a peds patient?

Answer 24

acute onset of multi-organ system dysfunction

AMS

respiratory compromis

metabolic acidosis

seizure without known disorder

Question 25

if there are signs of a toxic exposure, what must you rule out in a child \<1?

Answer 25

child abuse

Question 26

what's the preferred treatment for pediatric patients with hypertension resulting from ingestion?

Answer 26

benzodiazepenes nitroprussides

Question 27

Poison Antidote Chart for Peds

Answer 27

Question 28

what percentage of pediatric bite wounds are by humans?

Answer 28

2-3% dogs (60-90%) most common cats (5-20%)

Question 29

what are the predominant organisms in bite wounds?

Answer 29

gram -ve anerobes animals - pasturella humans - eikenella corrodens

Question 30

primary closure on pediatric bite wounds should be done only if:

Answer 30

cosmetically important area (e.g., face) clinically uninfected \<12 hour old bite (\<24 hours on the face)

Question 31

what's the antibiotic treatment for an animal bite?

Answer 31

Augmentin 20 mg/kg dose BID for 3-5 days

Question 32

what is the abx for human bites?

Answer 32

augmentin or ampicillin-sulbactam (Unasyn) 50 mg/kg per dose QID for 3-5 days

Question 33

What is the rx if the human biter is HbsAg+

Answer 33

initiate HB series vaccine in all unvaccinated HebB vaccine HepB immune globulin

Question 34

in a pediatric patient a 2kg weight loss equals how many liters of fluid?

Answer 34

2L

Question 35

what do you expect to find on labs in a peds patient with dehydration?

Answer 35

increased blood BUN serum bicarb \<17 mEq/L High serum sodium and potassium urine sodium, osmolatlity \>450 and high specific gravity \>1.015

Question 36

if oral fluid therapy is possible for peds dehydration what are the goals?

Answer 36

5 mL/2 min goal - 10ml/kg of body weight for each V/D episode

Question 37

what is the IV fluid of choice in pediatrics?

Answer 37

IV crystalloid isotonic 0.9% saline NEVER hypo or hyper crystalloids - no benefits to dextrose unless DM or burns

Question 38

What's the rate of fluid for pediatric dehydration?

Answer 38

emergent IV - rapid (bolus) infusion of 20mL/kg of isotonic sale in 10-30 minutes

Question 39

what's the epi of SIDS?

Answer 39

2-3x higher in AA and American Indian/Alaskan native babies peaks at 2-4 months, 90% of cases before 6 months mother: less than 20, smoker, drugs, delayed prenatal care, UTI/STIs

Question 40

where should you never use lidocaine with epi?

Answer 40

fingers, nose, penis, toes

Question 41

what are the main sedatives and analgesics used in peds ER procedures?

Answer 41