Trauma

Question 1

Management of shock in trauma APLS algorithm? Doses of fluid and drugs?

Answer 1

10ml/kg blood or warmed fluid

TXA 15mg/kg bolus
+ 2mg/kg/hr infusion

Question 2

How does primary ABCDE change with trauma

Answer 2

Catastrophic external haemorrhage

A + C-spine
- Jaw thrust
- Suction/removal of foreign body
- Intubation / surgical airway
- Neck collar

B
- Central trachea
- Chest movement
- Obvious chest injuries
- Auscultate

C
- CRT
- Radial pulse and rate
-Fluids
- 2x wide bore IV + Bloods inc Xmatch and lipase

D
- AVPU
- Pupils

E
- Abdo
- Femurs + pelvis

Question 3

Management of massive haemorrhage in paediatric trauma

Answer 3

Question 4

Secondary survey includes?

Answer 4

1) Surface (head to toe, front and back)

2) Orifice (mouth, nose, ears, anus, genitalia)

3) Cavity (chest, abdomen, pelvis)

4) Extremity (arms and legs)

Question 5

Paediatric traumatic cardiac arrest flow chart? What are the considerations for reversible causes

Answer 5

The search for and correction of any of the reversible causes of paediatric TCA should be prioritised. These include:

External exsanguinating haemorrhage should be controlled using direct pressure +/- tourniquets.

Bilateral finger or tube thoracostomy (or needle thoracocentesis) should be considered.

Fluid resuscitation should occur with blood products as soon as available.

Emergency thoracotomy should be considered in paediatric TCA patients with penetrating trauma with or without signs of life on arrival to ED.

Question 6

C-spine assessment algorithm

Answer 6

Question 7

When can you clear the C spine

Answer 7

Alert and awake, and not intoxicated

has no neck pain or visible injury to the neck

has no abnormal neurological limb signs

has no major painful distracting injuries

has normal radiology (if indicated

Question 8

Usual choice for a nerve block

Answer 8

buvipacaine 0.25%

Question 9

Paracetamol dosing in kids

Answer 9

20 mg/kg followed by doses of 15 mg/kg for a maximum of 4 doses in 24 hours.

Question 10

Intranasal fentanyl dosage for kids

Answer 10

1.5 microg/kg provides effective and rapid onset (5-10 mins) analgesia

Question 11

When is N2O contraindicated as pain relief

Answer 11

PTX

Nitrous oxide can diffuse into the pneumothorax airspace and may increase pressure or cause a tension pneumothorax

Question 12

2 options for raised ICP infusions

Answer 12

IV Mannitol 0.25-0.5 gm/kg

or hypertonic saline (3%) 3 mls/kg

Question 13

When should you treat a seizure if it occurs following trauma

Answer 13

Immediately

Question 14

Life threatening Major chest injuries

Answer 14

ATOMFC

A - Major airway compromise
T - Tension pneumothorax
O - Open pneumothorax
M - Massive haemothorax
F - Flail chest
C - Cardiac tamponadee

Question 15

What can you do in the community if open tension PTX

Answer 15

3 sided dressing

Question 16

Why do kids get more trauma of liver, pancreas and spleen

Answer 16

More flexible ribs

Horizontal diaphragm

Thinner abdo wall

Spleen also larger

Question 17

Initial pain relief in burns

Answer 17

Intranasal fentanyl

Cooling

IV morphine if IV

Question 18

When looking at burns on a limb or digit what are we concerned about

Answer 18

Encircling burns -> damage circulation -> compartment syndrome

[In order to prevent this tissues may need to be surgically divided, allowing tissues to expand without increasing pressures: a procedure known as escharortomy.]

Question 19

Assessment of burn % rough estimate

Answer 19

Question 20

Epidermal vs superficial vs mid dermal vs deep dermal vs full thickness
Colour, blisters, CRT, sensation?

Answer 20

Epidermal - no blisters
Superficial - blisters
Mid dermal - slow CRT
Deep - red + reduced sensation
Full - white + no sensation

Question 21

Painless burn

Answer 21

Full thickness

Question 22

Mottled, reddend, blistered with slow CRT

Answer 22

Mid dermal burn

Question 23

Pink blistered with fast CRT

Answer 23

Superficial dermal

Question 24

What is the parkland formula for burns fluids? How fast should you give it? Which fluid?

Answer 24

Parkland formula - Burn (in %) x Weight (in Kg) x 3 ml - (3mls per kg per % burn)

Half of this daily volume should be given in the first 8 hours and the second half given over the next 16 hours.

A balanced crystalloid such as Hartmann’s solution or Plasmalyte is generally recommended. Other crystalloid solutions such as normal saline can be considered.

Question 25

What is the correct estimate of fluid requirements due to burns fluid loss for a child with 40% burns (dermal) who weighs 20 kg?

Answer 25

The calculation is 40 (% burn) x 20 (kg) x 3 (mls) = 2400 mls to be given in 24 hours.

Half of this (1200 mls) is to be given in the first 8 hours: that is 150 mls per hour
followed by the second half over the next 16 hours: that is 75 mls per hour.