Pediatric Trauma

  1. What are three types of trauma?
    • Blunt trauma (80%)
    • Penetrating trauma (10%)
    • Thermal injuries (10%)
  2. What are Pediatric Provider's Nightmares?
    • Unrestrained kids
    • Heads without helmets
    • Abusive adults
    • Kids left alone in bathrubs
    • Trampolines
    • Chows/Rots/Pit Bulls
    • Walkers-entered into Nat'l database
    • Kids who can't fly (FTF)
  3. What are the mechanisms of injury and biomechanics?
    • Developmental stages influences MOI
    • Infants: falls, suffocation, NAT
    • Toddler/Preschooler: Burns, drowning, auto-ped, MVC, maltreatment, falls
    • School age: struck by vehicle, MVC, drowning, burns
    • Adolescent: MVC, homicide, suicide, poisoning
  4. What are anatomical and physiological factors to trauma?
    • increased resistance to trauma
    • chest wall is thin
    • rapid depletion of reserves
    • obligate nose breathers until 4 months
    • large head and tongue
    • fever alveoli, small lung volume
    • Neck is short and fat with weak muscles
    • fontanels are open in infants
    • occiput more prominant
    • thin, pliable cranium
    • lax ligaments
    • abdominal walls are thinner, weaker
    • higher center of gravity
    • liver is more anterior, kidneys more mobile
  5. Unique anatomic/physiological features of children
    • proturberant
    • organs are proportionately larger and more exposed
    • horizantal diaphragm and rib cage leave organs more exposed
    • Fewer fat deposits around abdominal and retroperitoneal organs
  6. Anatomic and Physiologic factors regarding the heart
    • stroke vol less in children
    • increase cardiac output by increasing heart rate
    • poor myocardial compliance
    • circulating blood volume is higher
    • higher % total body water
  7. How is temperature regulation different?
    • less effective thermoregulation mechanism
    • greater ratio body surface area to body mass
    • less subQ tissue
    • lose heat through their heads
  8. How are their developmental characteristics a risk?
    • Easily distracted, impulsive
    • Difficulty localizing sounds
    • Believe driver sees them because they see car
  9. What are neurological differences that put the child at risk for trauma?
    • White matter not well myelinated; sheaths around nerves less developed
    • Head is larger and heavy; cranium thinner, neck muscles weak, predisposes child to head and neck trauma
  10. What are unique anatomical and physiological features of children-misc?
    • immature immune system
    • varying VS
    • bones soft and pliable
    • fractures heal more quickly
  11. What is Waddel's triad when it comes to pedestrian injuries?
    prediction of injury with auto-ped: head, trunk, extremity
  12. What FOUR separate collisions occur during a MVC?
    • Vehicle strikes another object
    • Collision of the body with something in the car
    • Organs strike other organs, bone, muscles
    • Occurs if there are loose objects in the car that become projective forces
  13. Which is the most life-threatening of all pediatric injuries?
    • Trauma to the head & face
    • Leading cause of death for kids under 1
    • happens with boys more than girls
  14. What happens during air bag injuries?
    • can violently impact children
    • facial trauma
    • upper extremity fracture
    • intra-ab injury
    • abrasions
    • chemical irritation
    • cervical spine
    • decapitation
  15. What factors contribute to injuries in a fall?
    • velocity of the fall
    • child's body orientation at the time of the impact
    • type of impact surface
    • time that the force is applied to the body on impact
    • *Most often sports related
  16. What injuries are associated with bicycle injuries?
    pancreatic and duodenal
  17. Why is a craniofacial trauma an emergency?
    • Children can accumulate enough blood in their cranium to cause shock
    • Children at greater risk for secondary injury
  18. How do physical forces act on the head?
    • acceleration
    • deceleration
    • deformation
  19. How do you know if a kid has an acceleration/deceleration brain injury?
    demonstrate diffuse generalized cerebral swelling produced by increased blood volume or a redistribution or cerebral blood volume (cerebral hyperemia) rather than increased water content (cerebral edema) as seen in adults
  20. What are s/s of skull fractures?
    • fracture may or may not be palpable
    • pain and tenderness over the fx site
    • cephalohematoma
    • scalp laceration
    • rhinorrhea
    • hemotympanum
  21. What is a concussion?
    Closed head injury (CHI)
  22. S/S of a concussion?
    • N/V
    • HA
    • Dizziness
    • LOC
    • Behavior Change
    • *Worry about kids w/ witnessed LOC
  23. NI of Concussions
    • If vomit 3 or more times, need to be brought back to hospital
    • If obvious behavior changes....
    • Let sleep but check q 4hrs and must be arousable
  24. What is post consussive syndrome?
    Can happen 6 months after event
  25. What is a contusion?
    • Brusing characterized by areas of hemorrhage and edema
    • Often results in perm neuro deficits
  26. What are three types of intracranial hemorrhage?
    • Epidural hematoma: typical presentation->kid's alert, neuro exam stable, v's stable then coma quickly
    • subdural hematoma: venous bleed
    • subarachnoid hematoma: arterial bleed
  27. What is a contrecoup injury?
    • If smacked on one side but show symptoms on other side
    • Coup=point of injury
    • countrecoup=where we see symptoms
    • If glasgow less than 8, 50% mortality and if don't die, significant neuro deficit
  28. What do you want to do with a 2ndary injury/head trauma
    • Preven hypotension and hypoxia during acute phase
    • 2 predictors of poor outcome
  29. WHat are s/s of autonomic hyper-reflexia?
    • Thoracic 4-6 seg (Medical emergency)
    • HA
    • HTN
    • sweating
    • goose bumps
    • nasal obstruction
  30. How is AHR managed?
    • Sittint or erect so that blood pressure decreases
    • Check bladder catheter, test patency
    • elevate HOB
    • patient should be sitting
  31. What is Sciwora?
    • Significant spinal cord injury w/out radiographic evidence
    • Long term morbidity common and prognosis for functional recovery is poor
    • Onset up to 45 days
    • Spinal column stretches 2" but cord stretches up to 1/4"
  32. What is cardiothoracic Trauma?
    • Often component of major multi-system trauma
    • Rarely occurs alone
    • Occurs after blunt or penetrating mechanisms (rapid decel, increased velocity, firearms, falls)
    • Rib fractures=significant underlying injury
  33. What are s/s of cardiothoracic trauma?
    • resp distress
    • physical signs of trauma
    • paradoxical chest wall movement with breathing
    • Trach deviation
  34. What is a pneumothorax?
    • Air accumulates in open space
    • Open: loss in chest wall integrity and air enters the pleural space
    • Tension: air enters space on inspiration but can't escape on expiration
  35. What are s/s of pneumothorax?
    • tachycardia
    • tachypnea
    • cyanotic
  36. What is pericardial tamponade
    • Collection of blood in pericardial sac that prevents heart from being able to contract
    • As blood accumulates, exerts pressure on the heart and inhibits ventricular filling
  37. s/s of pericardial tamponade
    • decreased cardiac output
    • dyspnea
    • cyanosis
    • tachypnea
    • tachycardia
    • decreased pulses
    • Beck's triad: muffled heart sounds, JVD, decreased BP
  38. What are interventions for pericardial tamponade?
    • rapid crystalloid admin
    • pericardiocentesis
    • O2 admin
  39. What is the most unrecognized fatal injury in children?
    abdominal trauma
  40. What other organs does ab trauma affect?
    liver, spleen (LUQ)
  41. What are the 5 P's for musculoskeletal trauma?
    • pain
    • pulselessness
    • pallor
    • paralysis
    • parasthesia
  42. Most common types of shock?
    • hypovolemic: losing volume
    • cardiogenic: rare, acquired heart disease, drug ODs
    • obstructive: tension pneumothorax, temponade
    • Distributive: adequate volube but distributed in wrong places.
Card Set
Pediatric Trauma
pediatric trauma, exam II