School age: struck by vehicle, MVC, drowning, burns
Adolescent: MVC, homicide, suicide, poisoning
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
abdominal walls are thinner, weaker
higher center of gravity
liver is more anterior, kidneys more mobile
Unique anatomic/physiological features of children
organs are proportionately larger and more exposed
horizantal diaphragm and rib cage leave organs more exposed
Fewer fat deposits around abdominal and retroperitoneal organs
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
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
How are their developmental characteristics a risk?
Easily distracted, impulsive
Difficulty localizing sounds
Believe driver sees them because they see car
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
What are unique anatomical and physiological features of children-misc?
immature immune system
bones soft and pliable
fractures heal more quickly
What is Waddel's triad when it comes to pedestrian injuries?
prediction of injury with auto-ped: head, trunk, extremity
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
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
What happens during air bag injuries?
can violently impact children
upper extremity fracture
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
What injuries are associated with bicycle injuries?
pancreatic and duodenal
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
How do physical forces act on the head?
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
What are s/s of skull fractures?
fracture may or may not be palpable
pain and tenderness over the fx site
What is a concussion?
Closed head injury (CHI)
S/S of a concussion?
*Worry about kids w/ witnessed LOC
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
What is post consussive syndrome?
Can happen 6 months after event
What is a contusion?
Brusing characterized by areas of hemorrhage and edema
Often results in perm neuro deficits
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
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
What do you want to do with a 2ndary injury/head trauma