1
Q
What needs to be done immediately for a child with trauma?
A
* Circulation: check for external haemorrhage
- *A**irway (look, listen, feel) (jaw thrust only, head tilt dangerous) + c-spine
- *B**reathing (look, listen, feel. Three E’s). Check chest for injuries
- *C**- two wide bore IVL. Take bloods (GH, FBC, LFTs,UEs, glucose, ). Give fluid /warmblood at 10mL/kg +/- transfusion protocol or surgical review. Teanexamic acid 15mg/kg may be required
- *D** - AVPU preferred initially. ? any intracranial injury Analgesia as required
- *E** xposure
- Deal with life - threatening issues as they’re found
- Secondary survey: do after primary, to clarify and document injuries
- If ANY deterioration, abandon 2’ survey and restart primary
- Imaging
2
Q
What imaging is usually done in the immediate trauma
A
CXR
Pelvic XR
C-spine XR
3
Q
Secondary survey involves
A
- Surface (head-toe, front-back)
- Orifice (mouth, nose, ears, anus, genitalia)
- Cavity (chest, abdo, pelvis)
- Extremity (arms , legs)
4
Q
What are the differences between paediatric and adult C-spines
A
- occiput
- Laxer ligaments
- <8yrs upper 3 vertebrae
- >8yrs below C4
- Bones more difficult to assess
5
Q
You should immobilise a childs C-spine if…?
A
- Unconcious
- Trauma above clavicles
- Neck pain
- neurological signs in limbs
- Multitrauma / distracting injuries
6
Q
What imaging is usually done
A
- Plain XR
- Lateral C-spine
- Anteroposterior
- Odontoid vieiw (doesn’t work in uncooperative child)
7
Q
C-spine can only be CLEARED in a patient who is
A
- Fully conscious
- No neck pain
- No neurological signs in limbs
- No distracting injuries
- Normal Radiology
8
Q
What are the 6 major chest injuries kids can get after trauma?
A
- Major airway compromise
- Tension pneumothorax
- Open pneumothorax
- Massive pneumothorax
- Flail chest
- Cardiac Tamponade
9
Q
Major airway compromise: causes, signs and Tx
A
- Causes:
- Trauma to neck, face, jaw.
- Burns.
- Anterior neck trauma.
- Signs:
- E/O injury to these areas.
- Subcut emphysema.
- Stridor, noisy breathing
- Tx:
- High flow O2
- Suctioning
- Jaw thurst
- Adjuncts + prep for surgical aiway
10
Q
Tension Pneumothorax: causes, signs and Tx
A
- Causes:
- Blunt thoracic trauma
- Signs:
- tachypnea, tachycardia
- Hypotension
- Tracheal deviation
- Decreased AE + increased resonance ipsilateral
- Tx:
- high flow O2
- Needle chest decompression thoracocentesis + intercostal catheter
11
Q
Open Pneumothorax: causes, signs, tx
A
- Causes:
- Penetrating chest trauma
- Signs:
- Sucking chest wound sounds
- tachypnea, tachycardia, hypotension
- Tracheal deviation
- Decreased AE + increased resonance ipsilateral
- Tx:
- high flow O2
- Cover wound with 3-sided dressing
- intercostal catheter to drain
12
Q
Massive Haemothorax: causes, signs, tx
A
- Causes:
- Blood in pleural space
- Massive haemothorax: leads to circulatory impairment
- Signs
- Pallor, tachycardia, tachypnea
- Hypotension
- Hypoxia
- Reduced chest movement, air entry and resonances
- Tx:
- Urgent high flow O2
- Urgent fluids
- 2 large bore IVL
- Chest drain
13
Q
Flail Chest: causes, signs, tx
A
- Cause:
- When a number (2+) of ribs are broken on the same side > free floating chest wall
- Signs
- Abnormal chest wall movement
- Pain + +
- Subcut emphysema
- tachycardia, tachypnoea, hypocxis
- ** can be posterior, hard to know if splinting or intubated
- Tx:
- High flow O2
- IV opiod analgesia
- Observe closely - may need intubation
14
Q
Cardiac Tamponade: causes, signs, tx
A
- Causes
- Penetrating injury (more common) or blunt trauma
- Blood in pericardial sac
- Signs
- Hypotension
- Muffled HS
- Distended neck veins
- Tachycardic, tachypneic
- Tx:
- High flow O2
- IVF resus
- Needle pericardiocentesis
USS can be helpful!!
APLS
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