Trauma (peds): Difference between revisions
(Created page with "==Background== *Peds triad is appearance, work of breathing & circulation (skin color) *Childs size allows for dist of injuries, thus mutliple trauma is common & internal orga...") |
No edit summary |
||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
*Peds triad is appearance, work of breathing & circulation (skin color) | *Peds triad is appearance, work of breathing & circulation (skin color) | ||
| Line 8: | Line 6: | ||
*Wadell Triad in auto/ped= CHI, abd inj, femur Fx | *Wadell Triad in auto/ped= CHI, abd inj, femur Fx | ||
==AIRWAY/BREATHING== | |||
AIRWAY/BREATHING | |||
*Cricoid ring is narrowest part of airway allowing for uncuffed tubes up to 6.0 ETT or up to about 8 yrs | *Cricoid ring is narrowest part of airway allowing for uncuffed tubes up to 6.0 ETT or up to about 8 yrs | ||
==CIRCULATION== | |||
CIRCULATION | |||
*Key is to recognize & Rx shock early (before decr BP), s/s of shock= child may have lost 25% of BV | *Key is to recognize & Rx shock early (before decr BP), s/s of shock= child may have lost 25% of BV | ||
| Line 38: | Line 30: | ||
*Unstable pts, no response to IVF/PRBC= OR! | *Unstable pts, no response to IVF/PRBC= OR! | ||
==DISABILITY== | |||
DISABILITY | |||
*SCIWORA (2-21% of pts<8yr w/ spinal inj) | *SCIWORA (2-21% of pts<8yr w/ spinal inj) | ||
| Line 52: | Line 41: | ||
*80% of peds trauma deaths assoc w/ neurologic inj (see HCT/Head trauma memo) | *80% of peds trauma deaths assoc w/ neurologic inj (see HCT/Head trauma memo) | ||
==MISC== | |||
MISC | |||
*suspect physical abuse (cause of 60% femur fx if <1y & 100% non-supracond hum fx <3y), skeletal survey if <3y & suspect abuse. | *suspect physical abuse (cause of 60% femur fx if <1y & 100% non-supracond hum fx <3y), skeletal survey if <3y & suspect abuse. | ||
| Line 63: | Line 49: | ||
*Lat c-s xr alone misses 15% of fx! nd all 3 views. | *Lat c-s xr alone misses 15% of fx! nd all 3 views. | ||
==Source== | ==Source== | ||
Gausche 2004 -by Lampe | Gausche 2004 -by Lampe | ||
[[Category:Peds]] | [[Category:Peds]] | ||
[[Category:Trauma]] | |||
Revision as of 05:05, 9 June 2011
Background
- Peds triad is appearance, work of breathing & circulation (skin color)
- Childs size allows for dist of injuries, thus mutliple trauma is common & internal organs more susceptible to injury d/t more ant placement of liver & spleen (& less protective muscle & fat), Kidenys also less well protected and more mobile=more prone to decel injury
- Wadell Triad in auto/ped= CHI, abd inj, femur Fx
AIRWAY/BREATHING
- Cricoid ring is narrowest part of airway allowing for uncuffed tubes up to 6.0 ETT or up to about 8 yrs
CIRCULATION
- Key is to recognize & Rx shock early (before decr BP), s/s of shock= child may have lost 25% of BV
- BP not usu helpful sign of blood loss in peds, can be in shock w/ incr, decr or nl BP b/c kids are more effective at incre HR & SVR (pp=key)
- In field stop bleeding w/ pressure & elevation, MAST never shown to help kids
- In ED give IVF @ 20cc/kg, if unresponsive after 40cc/kg give PRBC @ 10cc/kg (can start w/ PRBC if presents in decompensated shock & multip inj suspected)
- Chest Tube in Peds is 4 X ETT
- Dip urine if NO blood stop, if blood send UA (+blood on dip= NO correlation w/ RBCs), if on UA >20 RBC's do CT to chk kidneys (Renal inj common, followed by bladder, urethra/ureteral are xtremely rare
- In sick trauma can skip c/s and just immobilize!
- CT A/P is study of choice but may miss hollow visceral injury (may take 1-2 days to see periton. signs)
- Shock w/ no response to IVF, think T-PTX or card tamponade
- Unstable pts, no response to IVF/PRBC= OR!
DISABILITY
- SCIWORA (2-21% of pts<8yr w/ spinal inj)
- C/S increased preodontoid space (up to 4-5mm vs 3mm in adult)
- pseudosubluxation C2 on C3 in 40% (up to teens), chk for true sublux by drawing line from ant cortical margin of spinous process (spinolaminar) of C1 to spinolaminar line of C3 (line of Swischuk), if line is >1-2mm from ant cort margin of C2 spinous process suspect TRUE sublux OR Fx!
- Chance Fx (L spine Fx) from forward flexion over lap belt (usu of L1-L4), 50% assoc w/ intraabdominal inj!
- 80% of peds trauma deaths assoc w/ neurologic inj (see HCT/Head trauma memo)
MISC
- suspect physical abuse (cause of 60% femur fx if <1y & 100% non-supracond hum fx <3y), skeletal survey if <3y & suspect abuse.
- missed inj common, usu d/t aloc, etoh. kids usu decr b/c we are hypervigilent. most common is muscskel so MUST xray joint above & below injured ext!! If BHT or ortho & nd OR r/o abd inj 1st!!
- Re-exam is key, try & do gd secondary survey before OR.
- Lat c-s xr alone misses 15% of fx! nd all 3 views.
Source
Gausche 2004 -by Lampe