Trauma (peds): Difference between revisions

Revision as of 13:44, 19 December 2015

Background

Key is to recognize & Rx shock early (before decr BP), s/s of shock= child may have lost 25% of BV
BP not usually 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)
80% of peds trauma deaths assoc w/ neurologic inj (see HCT/Head trauma memo)

Clinical Features

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

Differential Diagnosis

Diagnosis

CT A/P
- Significant intra-abdominal injury after blunt torso trauma highly unlikely (0.1%) if all of the following are true:
  - Glasgow coma scale ≥14
  - No evidence of abdominal wall trauma or seat belt sign
  - No abdominal tenderness
  - No complaints of abdominal pain
  - No vomiting
  - No thoracic wall trauma
  - No decreased breath sounds

Management

ATLS
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)

References

Holmes JF et al. Identifying Children at Very Low Risk of Clinically Important Blunt Abdominal Injuries. Ann Emerg Med. 2013

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
-*Significant intra-abdominal injury after blunt torso trauma highly unlikely (0.1%) if all of the following are true:
+*Key is to recognize & Rx shock early (before decr BP), s/s of shock= child may have lost 25% of BV
-**Glasgow coma scale ≥14
+*BP not usually 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)
-**No evidence of abdominal wall trauma or seat belt sign
+*80% of peds trauma deaths assoc w/ neurologic inj (see HCT/Head trauma memo)
-**No abdominal tenderness
-**No complaints of abdominal pain
-**No vomiting
-**No thoracic wall trauma
-**No decreased breath sounds
 ==Clinical Features==
@@ Line 15: / Line 10: @@
 ==Differential Diagnosis==
+*[[Trauma (main)|Standard trauma injuries]] plus:
 *[[Child abuse]]
+*[[SCIWORA]]
+*[[Chance fracture]]
 ==Diagnosis==
+*CT A/P
+**Significant intra-abdominal injury after blunt torso trauma highly unlikely (0.1%) if all of the following are true:
+***Glasgow coma scale ≥14
+***No evidence of abdominal wall trauma or seat belt sign
+***No abdominal tenderness
+***No complaints of abdominal pain
+***No vomiting
+***No thoracic wall trauma
+***No decreased breath sounds
 ==Management==
-===Airway/Breathing===
+*[[ATLS]]
-*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)
 ==See Also==