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What are three types of trauma?
- Blunt trauma (80%)
- Penetrating trauma (10%)
- Thermal injuries (10%)
What are Pediatric Provider's Nightmares?
- Unrestrained kids
- Heads without helmets
- Abusive adults
- Kids left alone in bathrubs
- Chows/Rots/Pit Bulls
- Walkers-entered into Nat'l database
- Kids who can't fly (FTF)
What are the mechanisms of injury and biomechanics?
- Developmental stages influences MOI
- Infants: falls, suffocation, NAT
- Toddler/Preschooler: Burns, drowning, auto-ped, MVC, maltreatment, falls
- 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
- lax ligaments
- 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
- varying VS
- 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
- facial trauma
- upper extremity fracture
- intra-ab injury
- chemical irritation
- cervical spine
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
- scalp laceration
What is a concussion?
Closed head injury (CHI)
S/S of a concussion?
- Behavior Change
- *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
- Preven hypotension and hypoxia during acute phase
- 2 predictors of poor outcome
WHat are s/s of autonomic hyper-reflexia?
- Thoracic 4-6 seg (Medical emergency)
- goose bumps
- nasal obstruction
How is AHR managed?
- Sittint or erect so that blood pressure decreases
- Check bladder catheter, test patency
- elevate HOB
- patient should be sitting
What is Sciwora?
- Significant spinal cord injury w/out radiographic evidence
- Long term morbidity common and prognosis for functional recovery is poor
- Onset up to 45 days
- Spinal column stretches 2" but cord stretches up to 1/4"
What is cardiothoracic Trauma?
- Often component of major multi-system trauma
- Rarely occurs alone
- Occurs after blunt or penetrating mechanisms (rapid decel, increased velocity, firearms, falls)
- Rib fractures=significant underlying injury
What are s/s of cardiothoracic trauma?
- resp distress
- physical signs of trauma
- paradoxical chest wall movement with breathing
- Trach deviation
What is a pneumothorax?
- Air accumulates in open space
- Open: loss in chest wall integrity and air enters the pleural space
- Tension: air enters space on inspiration but can't escape on expiration
What are s/s of pneumothorax?
What is pericardial tamponade
- Collection of blood in pericardial sac that prevents heart from being able to contract
- As blood accumulates, exerts pressure on the heart and inhibits ventricular filling
s/s of pericardial tamponade
- decreased cardiac output
- decreased pulses
- Beck's triad: muffled heart sounds, JVD, decreased BP
What are interventions for pericardial tamponade?
- rapid crystalloid admin
- O2 admin
What is the most unrecognized fatal injury in children?
What other organs does ab trauma affect?
liver, spleen (LUQ)
What are the 5 P's for musculoskeletal trauma?
Most common types of shock?
- hypovolemic: losing volume
- cardiogenic: rare, acquired heart disease, drug ODs
- obstructive: tension pneumothorax, temponade
- Distributive: adequate volube but distributed in wrong places.