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Pediatric Evaluation & Resuscitation

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Topic updated on 03/27/14 10:24pm
Epidemiology
  • Trauma is most common cause of death in children
    • mortality rate following pediatric polytrauma is 20%
    • CNS injuries have highest morbidity/mortality overall 
    • spine fracture have highest morbidity/mortality among musculoskeletal injuries 
      • cervical spine injuries more common in children <8-years-old
        • due to fact that restraints do not fit young children 
Transport
  • Occipital cut-out needed in spine board when transporting children <6 y.o. 
    • larger head size can flex unstable cervical spine leading to injury during transport
Resuscitation
  • Intraosseous lines commonly needed due to difficulty obtaining venous access
  • Children may remain hemodynamically stable even after significant blood loss
    • hypovolemic shock may result from inadequate fluid resuscitation
    • "triad of death" reflects inadequate resusitation and is characterized by:
      • acidosis
      • hypothermia
      • coagulopathy
    • estimate of blood volume for pediatric patients is 75 - 80 mL/kg 
Pediatric Scoring Systems
  • Pediatric trauma score (PTS) 
    • PTS<0=100% mortality
    • PTS of 1-4=40% mortality
    • PTS of 5-8=7% mortality
      • PTS less than or equal to 8 should be sent to designated peds trauma center
  • Pediatric Galsgow Coma Scale 
    • GCS<8 correlates with a higher rate of mortality
  • O2 sat at presentation and GCS 72hrs post-injury are both prognostic of long-term neurologic recovery
Injuries
  • Head and neck 
    • ICP can be elevated by pain
      • it is possible to decrease ICP by fracture fixation
    • heterotopic ossification is more common following traumatic brain injury
      • increase serum alkaline phosphatase heralds onset of HO
      • NSAID prophylaxis is indicated in these situations
  • Peripheral nerve injuries 
    • most common in closed fractures
      • obtain EMG if no return of function 2-3 months after injury

Management
  • Should follow ATLS protocol  
    • Airway
    • Breathing
    • Circulation
    • Disability
    • Exposure

 


 

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Qbank (5 Questions)

TAG
(OBQ11.62) A 5-year-old female presents after being struck by a vehicle in her driveway. She has multiple injuries, including a right femur fracture, and open book pelvis injury, and bilateral clavicle fractures. Peripheral IV access is not able to be obtained in the trauma bay after multiple attempts, and the patients blood pressure is 110/70. Which of the following is the most appropriate method to obtain vascular access in this patient? Topic Review Topic

1. Placement of an intraosseous infusion device
2. Peripherally inserted central catheter (PICC) placement in the upper extremity
3. Femoral venous cutdown
4. Subclavian central line placement
5. Continued attempts at obtaining peripheral IV access

PREFERRED RESPONSE ▶
TAG
(OBQ10.34) A 4-year-old child involved in a motor vehicle collision sustains multiple injuries including splenic rupture, bilateral open femur fractures, lumbar burst fracture with compression of the neural elements, and a closed head injury requiring a ventriculostomy. Of these injuries, which is likely to cause the greatest long-term morbidity? Topic Review Topic

1. Traumatic brain injury
2. Peripheral nerve injury
3. Vertebral column injury
4. Intra-abdominal injury
5. Open fractures

PREFERRED RESPONSE ▶
TAG
(OBQ10.192) How many milliliters(mL) of intravascular blood volume are present per kilogram of body weight in a healthy 5-year-old child? Topic Review Topic

1. 40-50 mL
2. 75-80 mL
3. 90-95 mL
4. 110-120 mL
5. 140-150 mL

PREFERRED RESPONSE ▶
TAG
(OBQ05.241) Which of the following injuries is associated with the highest risk of morbidity and mortality in a pediatric trauma patient? Topic Review Topic

1. Pelvic fracture
2. Scapula fracture
3. Spine fracture
4. Femur fracture
5. Tibia fracture

PREFERRED RESPONSE ▶
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