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Advanced Study | Pediatrics Part Seven

Trauma: 20-40% of pediatric deaths due to trauma are preventable. Most common: Falls, then MVA, accidental injury, sports related injury, assaults/abuse.

  • Assessment: ABCs
  • Treatment: IV saline or LR for hypovolemia
  • Head trauma: most common cause of death because their big, heavy heads hit first. Manage airway, O2, intubate as necessary
  • Spinal Trauma: more flexible, lack of neck muscle, serious injury can occur without external signs of injury. 60-70% of pediatric neck fractures are at C1 or C2

Child Safety Seats: Cervical spine is still susceptible to maximum flexion. If child’s head sticks up over the seat, the head can hyperextend during a rear-end collision. Use the seat for immobilization unless the child is critically injured and will deteriorate. Inspect the seat for damage too. Then pad the body and head to prevent further movement.

 

Chest and Abdominal Trauma: more flexible, fractured ribs are associated with a high mortality rate due to the force required to break the ribs. Flail segments rare. Liver, kidney and spleen are most commonly injured. Treatment: O2, transport definitive care at the hospital.

Hypothermia: CBT below 95 F, 35 C. Children more susceptible due to large body surface area compare to weight. Look for signs and symptoms:

  • 95 degrees – Shivering, increased resps, may be alert
  • 90 degrees – Muscular ridgity, decreased resp rate, atrial fibrillation, impaired cognition, loss of dexterity
  • 86 degrees – Decreased cerebral blood flow, tachycardia, tachypnea, supraventricular dysrhythmia
  • 80 degrees – bradycardia, bradypnea, V-fib, decreased O2 uptake, rigid extremities, metabolic rate decreased by 50%
  • 77 – hypotension, blood to kidneys reduced 30%
  • 68 – unconscious, no reflexes, unresponsive pupils etc.

Treatment: move to warm environment asap, warm blankets, maintain airway, high flow O2, CPR if no pulse, if heart rate, handle gently to prevent V-Fib. Use heat packs, but don’t let them directly touch the skin

Drowning: third leading preventable cause of death. 2,000 annually. Focus on ABCs. Do not intubate a child that has been submerged but has a heart rate – stimulating the vagus nerve may cause asystole.

  • Water rescue: distress in water but is alert
  • Submersion: water-related distress, transported to ER
  • Drowning: considered fatal. Drowning-related death is if they die within 24 hours

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