MOD E Tech Paediatric Trauma

Question 1

Paediatric Trauma

Causes of death in childhood

Answer 1

• SIDS (“Cot death”) – most common between 1 month and 1 year of age
• Between the ages of 1 and 4 the cause is equally split between congenital abnormality and trauma
• In the UK Trauma is the most frequent cause of death after 1 year of age

Question 2

Differences in response to injury between Adults and Children

Anatomical Considerations

Physiological Considerations

Answer 2

Anatomical Considerations

1. The large occiput
2. Compliant chest wall
3. Position of the abdominal organs

Physiological Considerations

• Smaller lung capacity
• Smaller blood volume
• Healthy hearts & extreme vasoconstriction
• Larger surface area
• Smaller glycogen stores

Question 3

Kinematics

Answer 3

Question 4

Assessment

• SCENE (“First 5”)
• <c>ABCDE</c>

Answer 4

Question 5

Airway

Answer 5

Question 6

Breathing

Answer 6

Question 7

Circulation

Answer 7

• Arrest any significant external bleeding
• Assess skin colour and temperature
• Capillary refill (sternum or forehead)
• Assess pulse rate and volume
• Signs of shock unlikely until at least 25% blood volume is lost

Question 8

Disability / Level of Consciousness

Answer 8

•Note initial LOC on the “AVPU” scale

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•If the patient does not score “A” then consider them time critical

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• Assess pupils
• Note any spontaneous limb movements
• Ask the patient to “wiggle” their fingers and toes
• Measure blood glucose level in any child with altered LOC
• Confusion or agitation in the child may arise directly from head injury or secondary to hypoxia from airway impairment, impaired breathing or hypovolaemia.
• After initial AVPU assessment, use revised GCS

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•Note any changes no matter how slight

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•Children loose heat rapidly – Keep warm!

Question 9

Head Injuries

Answer 9

•Children often fall head first

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•Must prevent secondary injury due to hypoxia by adequate management of:

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A + B = 100% Oxygen

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• Vomiting is common with paediatric head injuries so prevent aspiration and monitor GSC regularly
• The skull sutures fuse at approx. 12 – 18 months.
• Large intracranial bleeds can be accommodated without obvious abnormal neurological signs
• Deteriorating conscious level or development of unequal pupils mandates urgent removal to hospital

Question 10

Chest Injuries

Answer 10

• Fractured ribs and flail segments are rare in children
• Pneumothoraces and pulmonary contusions are more common – Tracheal deviation difficult to see due to chubby necks
• Be aware of the signs and symptoms of respiratory distress

Question 11

Spinal Injuries

Answer 11

•Rare, but can be catastrophic if present

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•Treat the same as for an adult

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•Pad under the shoulders to aid neutral positioning

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•Consider manual immobilisation

Question 12

Abdominal Injuries

Answer 12

• Blunt trauma is the second leading cause of death in children
• Skeleton protects abdominal organs less well in a child
• Thin abdominal wall transmits forces easily

–internal injuries without external signs

• GENTLE palpation
• Think SHOCK

Question 13

Extremity Injuries

Answer 13

• Bones are less likely to fracture
• Bones are able to absorb more force so underlying damage may be more severe
• Rapid healing of fractures
• Injuries to the growth plate can result in permanent deformity

Question 14

Thermal Injuries

Answer 14

• Burns and scalds are relatively common in children
• Consider NAI if the mechanism of injury and/or history do not match the sustained injury
• The Rule of Nines does not work in children <14years – use palmar surface
• Burns >10% TBSA = Time Critical