Trauma ✅ Flashcards

(72 cards)

1
Q

What is the most common cause of death in injured children?

A

Head injury

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2
Q

What is the principal determinant of outcome in multisystem trauma?

A

Severity of any head injury

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3
Q

What is the most common cause of severe head injury in young children?

A

Falls

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4
Q

What is the most common cause of severe head injury in older children?

A

Road traffic collisions, particularly from cycling accidents

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5
Q

What should be considered in all infants presenting with a head injury?

A

NAI

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6
Q

What can damage to the CNS caused by head injury be divided into?

A
  • Primary

- Secondary

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7
Q

What is a primary head injury?

A

An injured sustained as a direct consequence of the impact, causing disruption of the intracranial contents

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8
Q

Give 2 types of primary head injury

A
  • Diffuse axonal injury

- Vascular trauma

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9
Q

Why is diffuse axonal injury an important condition?

A

it is one of the most serious forms of primary neuronal injury, and is associated with high mortality and neurodisability

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10
Q

Why is DAI such a serious condition?

A

Because it results in widespread injury in the brain, not just in one specific area

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11
Q

What causes DAI?

A

Traumatic shearing forces due to rapid acceleration, deceleration, and/or rotation of the brain

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12
Q

What happens as the brain moves rapidly backwards and forwards in the skull?

A

The axons are disrupted, particularly at the grey-white matter junction

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13
Q

What do the clinical manifestations of DAI depend on?

A

The site and severity of axonal damage

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14
Q

What is a predominant feature of DAI?

A

Loss of consciousness

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15
Q

What imaging is useful in DAI?

A

MRI (not seen on CT)

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16
Q

How can trauma lead to vascular injury?

A

The force of impact may cause injury to intracranial blood vessels, leading to bleeding within the skull

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17
Q

What is an extra-axial bleed?

A

One occurring outside the brain

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18
Q

Of what type are most traumatic extra-axial bleeds?

A
  • Extradural

- Subdural

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19
Q

Where does blood accumulate in extradural haematomas?

A

Between dura mater and skull

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20
Q

Are extradural haematomas usually arterial or venous?

A

Arterial

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21
Q

Which vessel in particular commonly causes extradural haematomas?

A

Middle meningeal artery

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22
Q

What is the result of extradural haematomas commonly being arterial bleeds?

A

They develop rapidly

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23
Q

Where is the bleeding in subdural haematomas?

A

Between the dura mater and arachnoid mater

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24
Q

Are subdural haematomas usually arterial of venous?

A

Venous

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25
What is the result of subdural haematomas usually being venous?
They develop more slowly
26
What is the most common source of bleeding in subdural haematomas?
Bridging veins in the dural region
27
What can subdural and extradural haematoma lead to?
Raised ICP as the brain enlarges
28
What can the raised ICP in subdural and extradural haematoma lead to?
Mass effect and compression of brain tissue
29
What kind of haematoma is seen in non-accidental head injury?
Subural
30
When should suspicion be raised that a subdural haematoma is caused by non-accidental injury?
Incidental finding, or finding inconsistent with history given
31
Can traumatic subarachnoid haemorrhages occur in children?
Yes
32
What do traumatic subarachnoid haemorrhages often develop in close proximity to?
Cerebral contusions or skull fractures
33
What is a secondary head injury?
Further damage to the brain that can occur minutes to days after the original injury
34
Why is it important to recognise secondary head injury?
They are often either preventable or treatable, and failure to minimise its effects results in a poorer outcome
35
What is required to prevent/recognise secondary head injury?
Patients with significant traumatic brain injury need extremely close monitoring, especially in initial period after the injury
36
What is the aim of close monitoring following significant traumatic brain injury?
Prevention and treatment of complications which may give rise to secondary injury
37
What is true of the vast majority of paediatric head injuries?
They are mild
38
How is it decided if a child with a head injury requires neuroimaging?
Various criteria, related to both the history and examination, are used to try and predict the likelihood of intracranial pathology
39
Which factors, when present alone, indicate the need for CT scan following traumatic head injury?
- Suspicion of NAI - Post-traumatic seizure - GCS <14 on arrival at ED, or <15 if under 1 year old - Suspected open or depressed skull fracture - Evidence of basal skull fracture - Focal neurological deficit - Presence of bruise or swelling >5cm in diameter in children aged <1 year
40
Which factors, when 2+ present, indicate the need for CT scan following traumatic head injury?
- Witnessed LoC >5 mins - Abnormal drowsiness - >2 discrete episodes of vomiting - Amnesia >5 mins - Dangerous mechanism of injury
41
What are the advantages of using the NICE criteria for CT scan following traumatic head injury?
They have excellent sensitivity
42
What are the disadvantages of using the NICE criteria for CT head following traumatic head injury?
They have poor specificity and results in a significant number of normal scans
43
What is the aim of resuscitation in a child with severe head injury?
Maximise cerebral perfusion whilst minimising the effect of raised ICP
44
What is the outcome of a severe traumatic brain injury?
Likely to have a very long period of recovery, with intensive rehabilitation therapy, but likely to recover some function
45
What are the most common long-term sequelae of severe traumatic head injuries?
Cognitive, behavioural, and psychiatric problems
46
What can cognitive problems following traumatic brain injury lead ti?
Difficulty with memory, learning, and language
47
What behavioural and psychiatric problems may result from a traumatic brain injury?
- Personality changes - Lack of inhibition - Depression
48
What do the outcomes of severe traumatic brain injury vary depending on?
- Severity of injury - Age of child - Pre-morbid condition
49
What is the most common cause of spinal cord injury in children?
Road traffic collisions
50
What does the most common cervical fracture involve?
The first 2 vertebrae
51
What kind of spinal cord injury is almost exclusively a paediatric problem?
Spinal cord injury without radiologic abnormality (SCIWORA)
52
What does SCIWORA result from?
The elasticity of the cervical spine allowing significant cord injury in the absence of x-ray changes
53
What are the most common causes of thoracic injury in children?
- Road traffic accidents | - Falls
54
Are chest injuries more commonly caused by penetrating trauma or blunt trauma?
Blunt trauma
55
What do chest injuries usually occur in conjunction with?
Trauma to other body parts
56
How does the chest wall of children compare to adults?
It is much more complaint
57
What is the result of the chest wall of children being much more compliant than that of adults?
It leads to transfer of impact energy to underlying organs and structures with minimal, if any, external sign of injury or fracture
58
What does the presence of rib fractures or mediastinal injury indicate?
A very significant and high energy impact
59
What are the common thoracic injuries in children?
- Lung contusions | - Pneumothoraces
60
What causes lung contusions?
Energy being transferred rapidly into the lungs, causing haemorrhage and oedema in the lung tissue
61
How common is great vessel trauma in thoracic injury?
Very rare
62
Why are children more vulnerable to major abdominal injuries?
- Pliable rib cages, which provide little protection to solid organs - Solid organs proportionally larger than in adults - Abdominal wall thin and provides less impact absorption
63
Are abdominal injuries more commonly caused by blunt or penetrating trauma?
Blunt
64
What are the most common causes of abdominal injuries?
- Road traffic collisions - Set belt restraint - Handlebar injury
65
What is the result of intra-abdominal organs bleeding readily?
Can result in hypovolaemia and circulatory collapse
66
What can acceleration and deceleration forces cause?
Injury to organs, which are moved rapidly and may come into contact with the spine
67
Why are abdominal injuries dangerous?
They can be life-threatening and difficult to diagnose quickly in the absence of external signs
68
What abdominal organ injuries manifest rapidly?
- Spleen | - Liver
69
What abdominal organ injuries don’t become clinically evident for several days?
- Bowel | - Pancreatic
70
What is required as a result of the difficulty in diagnosing abdominal injuries?
An active approach to identifying abdominal injury, especially in high mechanism injuries
71
What is a useful tool in detecting abdominal injuries?
Focused abdominal sonography for trauma (FAST)
72
What is the limitation of FAST scanning?
- Can miss major solid organ injury | - Must be combined with clinical judgement