Trauma

Question 1

Pediatric blood volume

Answer 1

75-80ml/kg
BP waste of time until you have 25% blood loss

Question 2

GCS

Answer 2

Eye opening: 4 spont, 3 to voice, 2 to pain, 1 none

Verbal: 5 oriented, 4 confused, inappropriate words 3, incomprehensible 2, none 1

Motor: follows commands 6, localizes pain 5, withdraws 4, flexing 3, extension 2, none 1

Question 3

LeFort Fracture

Answer 3

Facial trauma
Rare in peds < 2
Lots of bleeding, decompress stomach

Question 4

Cardiac tamponade – Beck’s triad

Answer 4

Narrowing pulse pressure
JVD
Muffled heart tones
Widened mediastinum

Tx: pericardialcentesis

Question 5

Abdominal trauma

Answer 5

Spleen is the number one injured organ in trauma. Grade 5/6 liver injury is always fatal.
Colon or bowel trauma - most common from penetrating trauma, is usually from inappropriate seatbelt
Aorta trauma-20% of MVA fatalities have aortic involvement

Question 6

Pelvic trauma

Answer 6

Always assume there is pelvic trauma and use a binder. understand the vascularity involved in the pelvis so pelvic binder replacement should be a main stay with every single trauma.

The #1 pelvic trauma that leads to death is a vertical sheer pelvic fracture. pediatrics that fall from a high location or head on collision when people put their feet up on the dashboard 

Question 7

Burn %

Answer 7

Head and neck 18%
Trunk 18%
Whole arm 9%
Back 18%
Whole leg 14% 

Question 8

Fluid resuscitation in Burn Goal

Answer 8

Goal is UO
2ml/kg/hr of <10kg
1ml/kg/hr if >10kg

BP 90+ (2 X age)

Question 9

Parkland Formula

Answer 9

Kg X TBSA X 4ml= vol/24rs.
Take 1/2 of that and give it in 8hrs

Question 10

Consensus Formula
Burns

Answer 10

Combo of Brooks and Parkland

Kg X TBSA X 2-4ml= vol/24 hrs
Adults 2ml/kg
Peds: 3ml/kg
Electrical burns: 4ml/kg

Question 11

American Burn Association
Current guidelines formula

Answer 11

TBSA X kg X 1.5 / 8 =rate ml/hr

Adjust based on UO
Adults 0.5ml/kg
Peds > 10kg 1ml/kg
Peds < 10kg 2ml/kg

Question 12

A patient presenting with Beck’s triad is most likely experiencing?

Answer 12

Cardiac tamponade

Question 13

A patient presenting with beck’s triad is most likely experiencing?

Answer 13

Cardiac tamponade

Question 14

Eight-year-old patient had on accident showing signs of hypoxia with a NRB 15L. GCS 10 HR 139 BP 100/70 RR 28 shallow. Hgb 7 HCT 19. UO 0.5ml/kg/hr for last 3 hrs. What type of shock is the patient suffering from?
Hypoxic hypoxia
Stagnant hypoxia
Histotoxic hypoxia
Hypemic hypoxia

Answer 14

Hypemic hypoxia

The circulating blood volume for a pediatric patient is 75 to 80 mills per kilo. Remember it takes 25% blood loss to see clinical signs of decompensation and pediatric patient.

Question 15

7 kg patient involved in NBC that caught fire. She has received first-degree burns to her abdomen and lower back and second and third-degree burns to her face head and both arms. What percentage would you calculate her total body surface area burns as?
36%
63%
27%
33% 

Answer 15

36%

Question 16

Consensus formula calculates hourly fluid replacement for pediatric burn patients. What equation would you use?

5ml x kg x % BSA
4ml x kg x % BSA
3ml x kg x % BSA
2ml x kg x % BSA

Answer 16

3ml x kg x % BSA