Module 1: The Trauma Care Spectrum fully solved questions with 100% accurate solutions(Latest Update)

Trauma Scope & Impact

-Most frequent cause of childhood disability

-50,000 children acquire permanent disabilities yearly

-Most common are TBIs

Common Pedi Trauma Etiologies

Motor Vehicles

-over 460,000 U.S. children injured each year

-3,000 deaths

Falls

-most frequent cause

Firearms

-leading cause of childhood death

-63% homicides; 30% suicides

Field Triage: Red Criteria

Injury Patterns

- Penetrating injuries to head, neck, torse

- Skull deformities

- Suspected spinal, pelvic, fractures

-Active bleeding

Mental Status & Vitals Signs

- GCS <6

- Pulse Ox <90%

Field Triage: Yellow Criteria

Mechanism of Injury

- High-risk auto crash

- Partial/Complete ejection

- Death in passenger compartment

EMS Judgement

- anticoagulant use

- suspicion of child abuse

Trauma Center Classifications

Level I:

- full range of specialist available 24/7

- trauma residency program

Level II:

- comprehensive trauma care

- 24 hr availability of essential personnel

Level III:

- resources for emergency resuscitation

- general surgeon promptly available

Level IV:

- initial evaluation, stabilization, and diagnostic capabilities

Trauma Care Implications: Child Size

Due to different sizes IV fluid rates, blood product volumes, and medications are weight-based

urine output measured in mL/kg

Evaluate hemorrhage as a percentage of child's normal circulating volume rather than total milliliters of blood lost

Multisystem injury highly likely in peds

Pediatric Anatomic & Physiologic Difference: Cardiovascular

-Presume tachycardia is due to hypovolemia

-When their circulating blood volume is low, compensation is easier through tachycardia and vasoconstriction

-Maintain normal systolic blood pressure until more than 25-30% of circulating blood volume is lost

-Tachycardia is earliest indicator of hypovolemia

Pediatric Anatomic & Physiologic Difference: Respiratory

-In children ribs and weak intercostal muscles limit chest expansion, makes breathing less effective

-Higher chances of atelectasis, pneumonia, and respiratory failure

-High susceptibility to barotrauma from overinflation

-in small kids with no visible neck, tracheal deviation and jugular vein distention cannot be adequately assessed

Pediatric Anatomic & Physiologic Difference: Spinal Cord

-Large heads and weak neck muscles predispose to high c-spine injuries

-Most infant c-spine occur at C1-C2

Pediatric Anatomic & Physiologic Difference: Brain

-Due to lower BP at baseline, young children sustain fewer epidural hematomas than do older kids

-More likely to experience injuries that produce generalized edema such as contusions, anoxic damage, and diffuse axonal injuries

-Children have greater degree of neuroplasticity which allows non-injured areas of brain to compensate

Pediatric Anatomic & Physiologic Difference: Abdominal

-Asplenic children and those with severe spleen injuries require prophylactic antibiotics for at least one year after injury

-Lap belt injuries: bruising, redness, and abrasions across abdomen requires evaluation for intra-abdominal lower thoracic and lumbar injuires

Pediatric Anatomic & Physiologic Difference: Urine Output

-Children less than age 2 are unable to efficiently concentrate urine due to immature renal responses; continue to excrete urine even when hypovolemic

-Normal Infant Urine Output (1-2 mL/kg/hr)

-Young children urine output (1-1.5 mL/kg/hr)

-Adult urine output (0.5-1 mL/kg/hr)

Pediatric Anatomic & Physiologic Difference: Glycemic Control

-Limited glycogen stores and can quickly become hypoglycemic

Pediatric Anatomic & Physiologic Difference: Musculoskeletal

-higher chances of incomplete fractures as bones are softer and springier

-pulmonary contusions blossom over time (12-72 hours after injury). Anticipate onset of progressive ventilatory compromise in hours and days post injury

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Calculation of pediatric drug doses and fluid bolus volumes

Calculated by weight or length

Broselow tape: reliable way to identify appropriate medication doses in an emergency