MOD E Tech Paediatric Trauma Flashcards
Paediatric Trauma
Causes of death in childhood
- 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
Differences in response to injury between Adults and Children
Anatomical Considerations
Physiological Considerations
Anatomical Considerations
- The large occiput
- Compliant chest wall
- Position of the abdominal organs
Physiological Considerations
- Smaller lung capacity
- Smaller blood volume
- Healthy hearts & extreme vasoconstriction
- Larger surface area
- Smaller glycogen stores
Kinematics
Assessment
- SCENE (“First 5”)
- <c>ABCDE</c>
Airway
Breathing
Circulation
- 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
Disability / Level of Consciousness
•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!
Head Injuries
•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
Chest Injuries
- 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
Spinal Injuries
•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
Abdominal Injuries
- 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
Extremity Injuries
- 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
Thermal Injuries
- 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
