Week 9 Flashcards
what are the components of the AV paediatric assessment triangle.
Appearance
Work of breathing
Circulation to the skin
what are the elements to the appearance arm of the paed assessment triangle
- tone
- interactiveness
- consolability
- look/gaze
- speech/cry
what are the elements to the work of breathing arm of the paed assessment triangle
- abnormal breath sounds
- abnormal positioning
- retractions
- nasal flaring
what are the elements to the circulation to the skin arm of the paed assessment triangle
- pallor
- mottling
- cyanosis
what are the reasons of the injury patterns seen in paeds?
- multi-trauma more common
- anatomy closer together
- less body mass
- bones still flexible
- less muscle, less subcutaneous tissue`
whats the most common abdominal injury in paeds?
spleen (39%)
liver (37%)
- lose a lot of blood
what are the rules to exlcude intraabdo injury in paeds?
- no evidence of abdo wall trauma or seat belt sign
- GCS less than 14
- no abdo tenderness
- no evidence of thoracic wall trauma
- no complaints of abdo pain
- no decreased breaths sounds
- no vomitting
What is reponsible for 30-40% of traumatic death?
Exsanguination
- haem control
What are early signs of haemorrhagic shock in paeds?
- cool and pale extremities
- weak peripheral pulses and poor capillary refill
- mottled skin
- ACS
What should you consider with paeds and haemorrhage?
Children compensate well then deteriorate rapidly
- drop in blood pressure is a very late sign
what is a greenstick fracture?
bone bends instead of breaks
immature bone more flexible and thicker periosteum
- often mistaken for sprains
- more common in kids less than 10
what is the key difference bween a child and adults bone?
childs bone has physis (growth plate)
What is a type 2 physeal (growth plate) fracture?
- type 2 most common
- transverse fracture through growth plate and a verticle fracture through the metaphysics
what is a key consideration for a physeal injuries?
can heal very quickly, in a good or bad position.
- should be reduced within 24 hours
What are complications of physeal injuries?
Majority heal quickly and recover fully.
- it can however cause growth disturbance or arrest growth
What can cause physeal growth disturbances?
- avascular necrosis
- direct crushing
- the formation of a bny bar
- non-union
- hyperaemia
what is the number one cause of single body system death?
TBI
why are kids more likely to have TBIs?
- large head to body ratio
- skull bones thinner
- less myelinated brain tissue
- more susceptible to secondary injury (hypoxia/hypovolaemia)
When should TBI be considered with paeds?
- suspicion of mechanism of injury
- LOC
- multiple episodes of emesis
- needs airway management
- extracranial injuries
What do we want to know with neuro-trauma in a paed?
- time and mechanism of injury
- circumstances of injury
- LOC? and duration
- nausea and vomiting
- clinical course prior to consultation (stable/deteriorating/improving)
- other injuries sustained
- past history of bleeding tendency
- presence of amnesia
- post injury seizure
- presence of headache
When is neuro imaging required with neuro-trauma in paed?
- any sign of basal skull fracture
- focal neurological deficit
- suspicion of open or depressed skull fracture
- any GCS ubnder 8
- GCS persistently under 13
- suspected non-accidental injury
- seizures after impact
What are the signs of severe head trauma in paeds?
- GCS less than 8
- presence of focal neurological signs
- signs of intracranial haemorrhage
- signs of basal skull fracture
When should you consider intubation of a paed with head trauma?
- child unresponsive to pain or not responding purposefully
- GCS less than 8
- Loss of protective laryngeal reflexes
- respiratory irregularity or suspected hypoventilation
How many paed with spinal cord injury will have a TBI?
50%
