PAEDIATRIC TRAUMA. Learning outcomes Approach to patient Approach to patient Differences compared to...
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Transcript of PAEDIATRIC TRAUMA. Learning outcomes Approach to patient Approach to patient Differences compared to...
PAEDIATRIC TRAUMAPAEDIATRIC TRAUMA
Learning outcomesLearning outcomes
Approach to patientApproach to patient Differences compared to adult traumaDifferences compared to adult trauma Specific injuriesSpecific injuries
Head injuriesHead injuries Spinal injuriesSpinal injuries Abdominal injuriesAbdominal injuries ExtremitiesExtremities BurnsBurns
Children are not just little
adults!
TraumaTrauma
No 1 killer of after neonatal period No 1 killer of after neonatal period
50% of childhood deaths50% of childhood deaths
Cause of traumaCause of trauma
0-1 yrs – falls, burns, drowning, 0-1 yrs – falls, burns, drowning, suffocationsuffocation
1- 4yrs – RTC (occupant), burns, 1- 4yrs – RTC (occupant), burns, falls, drowningfalls, drowning
4-15yrs – RTC (occupant, pedestrian), 4-15yrs – RTC (occupant, pedestrian), bicycle injuries, burns, bicycle injuries, burns, drowningdrowning
Pediatric TraumaPediatric Trauma
Same PRIORITIES as adultsSame PRIORITIES as adults ABCABC’’s firsts first
Parents may want to be presentParents may want to be present
Remember analgesiaRemember analgesia
Airway - problemsAirway - problems
At increased risk of At increased risk of obstruction obstruction Large headLarge head Short neckShort neck Small oral cavitySmall oral cavity Large tongueLarge tongue <6mths nasal <6mths nasal
breathersbreathers
Airway - managementAirway - management
Neutral position in Neutral position in infantsinfants
SuctionSuction Jaw thrustJaw thrust Adjuncts Adjuncts
BreathingBreathing
Respiratory FailureRespiratory Failure
Leading Cause of Pediatric Cardiac ArrestLeading Cause of Pediatric Cardiac Arrest
BreathingBreathing
Increased respiratory rateIncreased respiratory rate What is normal for 8 month old?What is normal for 8 month old?
• Slow rate = impending arrestSlow rate = impending arrest
AGE NORMAL RR
<1 YEAR 30-40
2-5 YEARS 25-30
5-12 YEARS 20-25
>12 YEARS <20
BreathingBreathing
3 Es:3 Es:• EffortEffort – grunting, RR, nasal flaring, – grunting, RR, nasal flaring,
recession, use of accessory musclesrecession, use of accessory muscles
• EfficacyEfficacy – chest expansion, breath – chest expansion, breath soundssounds
• EffectEffect – cyanosis, oxygen sats, mental – cyanosis, oxygen sats, mental statusstatus
BreathingBreathing
Trauma specific: Trauma specific: • contusions contusions • wounds wounds • subcutaneous subcutaneous
emphysemaemphysema
BreathingBreathing
Pliant chest wallsPliant chest walls Rib fractures rareRib fractures rare Pulmonary Pulmonary
contusions commoncontusions common
Breathing - managementBreathing - management
OxygenOxygen Ventilate / intubate if required Ventilate / intubate if required Analgesia Analgesia Treat pneumothorax if presentTreat pneumothorax if present
CirculationCirculation
Silence is not Silence is not GoldenGolden
CirculationCirculation
Small blood Small blood volumevolume
Good Good initialinitial compensation for compensation for hypovolemiahypovolemia
CirculationCirculation
BP monitoringBP monitoring Poor methodPoor method
To assess perfusion, check:To assess perfusion, check: Pulse rate, quality of peripheral pulsesPulse rate, quality of peripheral pulses Skin temperatureSkin temperature Capillary refillCapillary refill Level of consciousnessLevel of consciousness
Shock ManagementShock Management
Keep warmKeep warm Fluid Resuscitation-Fluid Resuscitation-
Volume weight basedVolume weight based ReassessReassess Repeat boluses as indicated by responseRepeat boluses as indicated by response
Special circumstancesSpecial circumstances
Head TraumaHead Trauma
Major cause of deathsMajor cause of deaths
Unfused sutures allow significant Unfused sutures allow significant intracranial haemorrhage which can lead intracranial haemorrhage which can lead to shockto shock
Scalp wounds can lead to anaemiaScalp wounds can lead to anaemia
Head TraumaHead Trauma
Key symptoms – headache, vomiting, Key symptoms – headache, vomiting, irritability or drowsinessirritability or drowsiness
Neurological examination varies with age - Neurological examination varies with age - Observation keyObservation key
Severe Head TraumaSevere Head Trauma
May need to intubate to scanMay need to intubate to scan Controlled ventilationControlled ventilation
Maintain normal BPMaintain normal BP
CPP = MAP - ICPCPP = MAP - ICP
Spinal TraumaSpinal Trauma
SCIWORA – Spinal cord injury withoutSCIWORA – Spinal cord injury without
radiographic abnormality radiographic abnormality X-rays and CT look normalX-rays and CT look normal Usually affects spineUsually affects spine Due to elasticity of spineDue to elasticity of spine Abnormalities now usually seen on MRIAbnormalities now usually seen on MRI
Abdominal TraumaAbdominal Trauma
Primarily bluntPrimarily blunt Organs are vulnerableOrgans are vulnerable Spleen, liver = Most common injuriesSpleen, liver = Most common injuries
High costal archHigh costal arch Relatively larger organsRelatively larger organs Poor abdominal muscle developmentPoor abdominal muscle development
Abdominal TraumaAbdominal Trauma
Contusions Contusions TendernessTenderness Unexplained hypovolemic shockUnexplained hypovolemic shock
Extremity TraumaExtremity Trauma
Never warrants attention before head, Never warrants attention before head, chest, abdomen injurychest, abdomen injury
Think of neurovascular supplyThink of neurovascular supply Evaluate distal extremity for:Evaluate distal extremity for:
Skin color, temperatureSkin color, temperature Motor, sensory functionMotor, sensory function Capillary refillCapillary refill PulsesPulses
BurnsBurns
Pediatric patientsPediatric patients 50% of burn admissions50% of burn admissions 33% of burn deaths33% of burn deaths
Challenges due toChallenges due to Immature immune systemImmature immune system Small airways – increased Small airways – increased
complicationscomplications Fluid and heat lossFluid and heat loss
REMEMBER IN ALL CASES REMEMBER IN ALL CASES
TO CONSIDERTO CONSIDER
POSSIBLE NON ACCIDENTAL POSSIBLE NON ACCIDENTAL INJURYINJURY
QuestionsQuestions
SummarySummary
Same PRIORITIES as treating adultsSame PRIORITIES as treating adults ABCsABCs
Neutral head position in infantsNeutral head position in infants Prone to intra-thoracic and abdominal Prone to intra-thoracic and abdominal
organ injuryorgan injury Will compensate until fall off cliffWill compensate until fall off cliff