PAEDIATRIC TRAUMA MODULE
|
|
- Brooke Shanna Marshall
- 6 years ago
- Views:
Transcription
1 INTRODUCTION PAEDIATRIC TRAUMA MODULE Trauma is the most common cause of death and disability in children and adolescents. From an ED Trauma perspective, THEY ARE LITTLE ADULTS, with a few nuances. Mechanism varies with age: Motor vehicle accidents most common mechanism across all ages over 1 year of age Pedestrian struck Fall Drowning Burns Push-bike accident Sport related Non-accidental injury (may account for up to 10% of all injury, requires vigilance) General Principals 1 : The sequence of ABCDE remains the same, with nuances Generally children are smaller in size and have smaller body mass, so a large force of impact is potentially applied to a smaller area. Their smaller size means that multiple systems injuries are the more likely Smaller size means head and thorax are more readily involved in pedestrian v car Have a large body surface area to weight ratio - get cold quickly Have pliable bones, forces are more readily transmitted to underlying organs Vital signs vary with age Hypotension is a LATE sign of shock Psychological / developmental considerations difficult to get a history, easily distressed by surroundings. General anaesthesia may be required to allow adequate investigation Family distressed or absent parents (may be injured themselves). Parents may also be effective in keeping the patient calm on initial assessment Size and weight: o Modification to equipment required o Weight based drug and fluid doses Best managed in a paediatric trauma centre, may require transfer once stabilised
2 Useful Equations Based on Weight: Weight: (Age + 4) x 2 up to 10 yo ETT size: (Age/4) + 4 ETT length at the teeth: (Age/2) + 12 Doses: Fentanyl 1-3 mcg / kg Morphine 0.1 mg/kg Midazolam 0.1mg/kg Ketamine 1-2 mg/kg for induction; 0.5 mg / kg for procedural sedation; 0.1 mg/kg for analgesia Propofol 1-2 mg/kg for induction Rocuronium mg/kg for paralysis Suxamethonium mg / kg Fluids ml /kg boluses Blood 10 mg /kg boluses INJURY PATTERNS Head: Larger head, more vulnerable to injury Closed head injury, with increased blood flow; more susceptible to hypoxic insult Impact seizures are common, do not necessarily correlate with radiologically identifiable injury Spine: Paediatric spinal injuries are uncommon, spinal cord injury even less common. Anatomical considerations include relative ligamentous laxity, shallow angulation of facet joints, immature muscles, incomplete ossification of vertebrae and the disproportionately large head with the fulcrum of movement being C2-3 in infants, C3-4 at 6 yo, and C5-6 at 8 yo % of all paediatric spinal injuries are in the c-spine, especially the C1-3 Chest: SCIWORA secondary to pliable bones and ligaments. However, SCIWORA is probably a misnomer due to sensitivity of MRI in detecting radiological abnormality Pliable bones that are less likely to fracture but allow the transmission of force to underlying structures (e.g. pulmonary contusion) increasing the risk of major internal injury with little external evidence of trauma Rib fractures required significant force, so expect associated injuries Most common injuries are pulmonary contusion, rib fractures, pneumothoraces and haemothoraces. Diaphragmatic rupture, aortic disruption, cardiac contusions, tracheobronchial disruption is rare Paediatric patients have a smaller Functional Residual Volume and higher oxygen demand, so will desaturate faster than adult patients
3 Abdomen: Gastroparesis even with minor trauma Swallow lots of air when distressed, which splints the diaphragm, impairing ventilation, and possibly making clinical assessment of the abdomen difficult Large, unprotected intra-abdominal solid organs at risk of injury (rib cage does not extend as far caudally as in adults, the musculature is less well developed and ribs are more compliant) Handlebar injuries duodenal haematoma, pancreatic haematoma / laceration Bladder rupture as intra-abdominal Pelvis: Greater bony compliance and joint elasticity, therefore pelvic fractures suggest major force and increases the likelihood of associated head, chest and intra-abdominal injury Avulsion fractures and single fractures to the pelvic ring are more common in paediatric than adult patients NAI Consider if any of the following: Multiple fractures of varying ages, bilateral fractures Shaken baby - Subdural haematoma, Retinal haemorrhages Peri-orbital injuries Genital injuries Burns Rib fractures Unusual skin bruising patterns i.e. linear bruising on upper arms suggesting of being squeezed, bruises of varying age Injury not consistent with mechanism or age appropriate ASSESSMENT Assessment of paediatric trauma patients should follow the same process as for adults to identify and consequently manage life-threatening issues. There are some anatomical differences when assessing and managing paeds that will be covered in the relevant sections. HISTORY Handover from QAS with particular consideration of mechanism. The mechanism is an important aid when trying to determine possible patterns of injury. Restrained patient Evidence of airway injury Evidence of ventilatory impairment Evidence of circulatory impairment GCS more difficult to determine in children, ask about appropriate crying, interaction, alertness Specific injuries
4 Normal Vital Signs 1 Age Weight kg RR HR SBP (mmhg) Birth 6 months 1 year 2 years 4 years 6 years 8 years 10 years 12 years 14 years EXAMINATION Immediate priority is to identify life threats: AIRWAY Airway obstruction large occiput that may cause neck flexion, requiring padding between shoulder blades to allow for adequate positioning; injuries that may involve / cause airway obstruction Risk of C-spine injury based on mechanism and identified injuries, do not forcefully restrain a child s c-spine, it s best to try to calm the patient using parents, analgesia etc In an intubated patient, confirm tube position and placement (ETTs easily migrate or dislodge in paediatric patients). An intubated right main bronchus may mimic life-threatening chest trauma (i.e. tension pneumothorax, pulmonary contusion, massive haemothorax) BREATHING Ventilatory distress or impending failure Evidence of chest trauma and associated injuries particularly the presence of a tension pneumothorax, rib fractures, pulmonary contusion, massive heamothorax, open pneumothorax CIRCULATION Paediatric patients have increased circulatory reserve, able to tolerate significant blood loss before hypotension occurs. Hypotension is a late sign and is a marker of precipitous deterioration. Bradycardia may also be an indication of imminent arrest Look for markers of poor perfusion / shock tachycardia, reduced pulse volume, cool peripheries, reduced capillary refill, ALOC. Ongoing tachycardia may be a marker of internal bleeding in the absence of evidence of significant external injury Look for blood loss external, chest, pelvis, abdomen, muscle compartments
5 Measure NIBP using an appropriately sized cuff DISABILITY AVPU is easier than GCS in a child. A score of P or U corresponds with a GCS <=8 Assess pupil size and responsiveness Perform gross neurological exam assessing for focal / localising signs suggestive of closed head injury or spinal injury Tense fontanelle suggest intra-cranial injury EXPOSURE Will be at risk of hypothermia if not covered. Exposure is important to look for seat-belt signs, handle-bar injury or other external evidence of trauma, but avoid unnecessary exposure Rectal exam is almost never indicated (exceptions may include suspected spinal injury, compound pelvic fracture) SECONDARY SURVEY Completed once life-threatening issues have been identified and treated, and consists of a detailed head to toe examination, paying particular attention long bones, hands, clavicles, neurovascular status of limbs, spine assessment and a more thorough neurological examination Intra-abdominal injury may be masked by an altered level of consciousness, distracting injury or a patient who is frightened and non-cooperative. Serial examination is important. INVESTIGATIONS Standard baseline trauma bloods will only be indicated in significant mechanisms of injury and they include o Blood gas - will reveal ventilation inadequacy and evidence of hypoperfusion o Note that LFTs and Lipase are not sensitive or specific for liver and pancreatic injury o BSL to exclude hypoglycaemia Urine: Blunt trauma as for adults, frank haematuria indicates an injury anywhere along the renal and genitourinary tract. Microscopic haematuria in the setting of hypotension warrants further investigation as the degree of haematuria does not correspond to the degree of injury. 13 Penetrating trauma - macroscopic haematuria indicates renal or bladder injury 3 ECG is routine in trauma patients, especially patients with chest trauma FAST (Focused Abdominal Sonography for Trauma) can be performed in blunt abdominal injuries to identify haemoperitoneum and pericardial tamponade.
6 FAST is not as well researched in children as adults, although sensitivities have been reported to be approach 100% in the unstable, multiply injured paediatric patient 1. The primary role of FAST is in unstable patients suffering from blunt trauma to direct the team to the abdomen as a source of bleeding, facilitating early laparotomy. However, the role is less certain than for adults as in many situations paediatric patients with free fluid from solid organ injuries are managed conservatively. It is important to note that FAST does not detect hollow viscous injury, most of which mandate laparotomy. Stable patients with concerns for intraabdominal injury (tenderness, guarding, rebound or rigidity) should have a CT. Plain film Trauma Series: CXR Pelvis XR if clinically indicated C-spine Plain Films use clinical judgement and decision rules if required (see below) USS has been supplanted by FAST and the fact that CT has become more readily available. Scan quality is impacted by abdominal distension secondary to gastric stasis / ileus and compliance of the patient with abdominal tenderness. The only real benefit over CT is the lack of radiation, but it has a much lower diagnostic yield compared to CT. CT: Often used in the setting of clinical decision rules in paediatric patients (see below),to minimise exposure to radiation. CT is the examination of choice for: Non-contrast CT head is the modality of choice for suspected closed head injury as quickly identifies injuries that may benefit from neurosurgical involvement (see below for clinical decision rules) Spinal injury (see below) Stable paediatric patients where there is a concern for intra-abdominal injury Chest trauma, especially where the CXR is abnormal or where there is external evidence of chest trauma (seat belt sign). Clinical Decision Rules Clinical decision rules can be used to guide CT imaging for paediatric patients with suspected isolated minor head injury and / or spinal injury. They have no role in decision making for the multi-injured patient requiring CT for other reasons. CT decision rules were derived to reduce the number of un-necessary CT head and spine scans in the paediatric population, reducing radiation exposure and ultimately cost, while minimising the risk of missing clinically important traumatic brain and cervical spine injury. Decision rules are not a substitute for clinical judgment. There are several decision rules available:
7 PECARN (Pediatric Emergency Care Applied Research Network) CT Head Algorithm for Children < 2 (A) and > 2 years old (B) 3 The above algorithm was derived and validated across 25 emergency departments in North America enrolling patients under 18 years of age, of which were younger than 2 years of age. Clinically important traumatic brain injury was defined as death from traumatic brain injury, injury requiring neurosurgical intervention, intubation for > 24 hours due to TBI, hospital admission for more than 2 nights in association with TBI on CT. TBI in 376 children (0.9%) and 60 (0.1%) required neurosurgical intervention. In the < 2 y age group, the rule had a negative predictive value of 100% and a 100% sensitivity for clinically significant TBI. In the > 2 y age group the negative predictive value was 99.95% and sensitivity of 96.8% (did not miss injury requiring neurosurgical intervention). The above algorithm if applied would have led to a reduction of CT scans by 25% in children < 2 y and 20% for children > 2 y. CHALICE CT Head Rule 4 The Children s Head Injury Algorithm for the prediction of important Clinical Events rule (CHALICE) was developed in the UK to be applied specifically to the paediatric population across children presenting with any head injury over 2.5 years. The rule had a 98% sensitivity for predicting clinically significant TBI, and if applied would have led to a CT scanning rate of 14% of the total number of children presenting with a head injury. 1.2% of the study population had an abnormal CT, half requiring neurosurgical intervention.
8 CHALICE rule A CT scan in required in any of the following criteria are present: HISTORY Witnessed LOC > 5 min History of amnesia > 5 min Abnormal drowsiness 3 vomits post injury Suspicion of NAI Seizure of head injury in a patient with no history of epilepsy Examination GCS < 14 or GCS < 15 if under 1 yo Suspicion of penetrating/depressed skull injury or tense fontanelle Signs of BOS # Focal neurology Presence of bruise, swelling or laceration > 5 cm if under 1 yo MECHANISM High speed MVA (pedestrian, cyclist or occupant) Fall > 3 m High-speed head injury from a projectile Assessment of Possible C-Spine Injury in Children Suffering Blunt Trauma The Queensland Paediatric Trauma Service has developed an evidence based pathway for assessing the c-spine of children involved in blunt trauma 5, based on the fact that serious cervical spine injury in blunt trauma is uncommon in the paediatric population (1% of all paediatric blunt trauma cases, incidence ranging from 0.4% in pre-school age to 2.5% in adolescents). The majority of these injuries are stable with only 1-5% requiring operative fixation. Imaging plays an important role in identifying injuries, but has an associated increased life-time risk of malignancy, albeit poorly defined. The PECARN group has identified 8 factors which associated with C-spine injury that form the basis for the clinical algorithm put forward by the Queensland Paediatric Trauma Service:
9 If a patient is having a CT for other injuries, then serious consideration should be given to concurrent CT of the spine. MANAGEMENT Key Issues: A team approach to management occurs in a trauma / resus bay with appropriate nursing and medical staff, equipment and monitoring The goal of management is to treat acute life threats, and facilitate progression towards definitive intervention Psychosocial support for the child allow / facilitate parents to stay in resus room if possible and able to provide adequate support, especially for nonintubated children Family support social work involvement If suspect NAI, there is a legal obligation to report
10 AIRWAY Apply oxygen and titrate to O2 sats >=95% C-spine precautions Basic airway manoeuvres and use of adjuncts as required o Adjuncts Smaller, appropriately sized equipment required. Place guedel without rotating, using a tongue depressor as required Advanced airway as indicated same as for adult: o Impending, potential or actual loss of airway o Ventilatory compromise o Unconsciousness o Agitation requiring sedation or significant ALOC post head injury o Anticipated clinical course o Humane reasons Anatomical considerations that may impact on paediatric airway management: Large occiput that causes passive flexion of c-spine. Paeds patients may require padding under the shoulder blades to allow appropriate positioning Large tongue U-shaped, large and floppy epiglottis that may make visualisation of the cords difficult, requiring a straight (Millers) blade in younger patients (<2) Larynx funnel shaped, more anterior and cephalad making visualisation of the cords potentially more difficult Short trachea increases possibility of right main bronchus intubation, migration of the tube on neck flexion and accidental extubation on neck extension Desaturate quickly due to smaller FRC and high metabolic rate with higher O2 consumption Move towards using cuffed tubes BREATHING Manage associated chest injuries o Tension pneumothorax (needle thoracostomy or simple thoracostomy followed by ICC placement) o Massive haemothorax by ICC placement Note that paediatric patients have a higher respiratory rate, smaller tidal volume, less FRC and higher oxygen demand Intubated paediatric patients should be ventilated at a rate appropriate for their age, and a tidal volume 8-10 ml/kg At risk of barotrauma Early decompression of the stomach via a NGT / OGT will assist in ventilation and should be performed routinely and as soon as possible in intubated children
11 CIRCULATION Control external haemorrhage IV access can be difficult in the paediatric population. Potential sites other than the cubital fossae or back of the hands include the external jugular vein and femoral vein. If peripheral cannulation is unsuccessful after 2 attempts, consideration should be given to rapid IO insertion Permissive hypotension has not gained widespread acceptance at this time. Haemostatic resuscitation along the same lines as for adult patients is gaining more acceptance Warmed 0.9% saline 20ml/kg boluses x 3 then PRBC 10 ml / kg is the standard APLS teaching although in large volume blood loss there is a trend towards minimising crystalloid and initiating blood products earlier. SPECIFIC THERAPY Head: Prevent hypoxia and hypotension and maintenance of cerebral perfusion pressure. Volume load aiming for an age appropriate MAP / SBP, consider inotropes to achieve this after excluding other causes of bleeding, and after a total of 40 ml/kg 0.9% saline If evidence of raised intracranial pressure (e.g. unilateral dilated pupil, bilateral fixed and dilated pupils etc): 5ml / kg 3% hypertonic saline boluses to maintain Na ensure adequate sedation Head-up 30 degrees Loosen ETT ties to ensure venous return from the brain neuromuscular blockade consider cooling (aiming for T o of 34 o C) consider repeat CT head urgent neurosurgical intervention Early post-traumatic seizures (within 7 days of TBI) are common, with 80% occurring in the first 24 hours. Seizures may increase the risk of / exacerbate secondary injury through increasing ICP, metabolic demands and causing hypoxia. Consider seizure prophylaxis (Phenytoin load 20 mg/kg over 30 min - hour) if a structural abnormality is present on CT and in consultation with neurosurgery Spine: Immobilisation may be difficult especially in smaller children / infants. A riskbenefit judgment must be made between keeping small children spinally immobilised to prevent secondary injury vs comfort and distress of the child. Allowing a conscious, cooperative child to find their position of comfort may be more effective in settling the child and allowing assessment. Furthermore, patients who become distressed / agitated with external devices may be at risk of increased instability due to non-anatomical mechanical fixation point 5. Children under 10 who are being kept flat may need a thoracic elevation device to keep alignment of the cervical spine neutral, overcoming a Cobb angle (the difference in the inclination of lines drawn parallel to the inferior end plates of C2 and C6
12 Chest: Minimise IV fluid where possible if pulmonary contusions are present Incidental pneumothorax may be managed conservatively in a non-compromised spontaneously breathing patient, and in a haemodynamically normal ventilated patient who will be closely monitored (i.e. PICU) Massive haemothorax indications for thoracotomy: o Initial drainage exceeding > 15 ml/kg estimated blood volume o Continued bleeding > 1-2 ml/kg/hr Abdomen: Facilitate senior surgical involvement where indicated to assist in decision making regarding management of intra-abdominal injury Selective non-operative management of solid intra-abdominal organs is the norm, with operative management being the exception Hollow viscous injuries are usually explored in theatre, except duodenal haematoma without evidence of perforation, which may be managed conservatively Pelvis: Consider splinting the pelvis in unstable patients with concerns for or actual AP compression fracture Vascular injury is rare in paediatric patients Facilitate orthopaedic involvement in decision making regarding pelvic fractures and IR if evidence of arterial bleeding on CT or the pelvis is the most likely source of blood loss in an unstable patient Isolated pelvic injuries rarely cause haemodynamic instability as they do in adults, consider other injuries in this scenario. Limb fractures / dislocations: Early splinting for analgesia particularly prior to transfers to radiology as reduces pain on transfer Early reduction where required and plaster immobilisation as appropriate o There is enough evidence showing that procedural reduction does not require a patient to be fasted, and that paediatric patients suffer gastroparesis even with minor trauma, making delays to achieve a fasting state inappropriate SUPPORTIVE Analgesia o IV Fentanyl at 1 mcg/kg; morphine at 0.1mg/kg, titrated to effect o Intranasal Fentanyl at 1.5mcg/kg Antiemetic - Ondansetron 0.1 mg/kg Monitor fluid balance and ensure adequate maintenance fluids Monitor temperature Monitor electrolytes
13 DISPOSITION Depends on injuries identified. There is a low threshold to admit paediatric patients exposed to significant mechanism for observation even if no significant injuries have been indentified All children with suspicion of NAI should be admitted to the hospital for safety and further evaluation. A discussion should occur with the local child protection service directly. REFERENCES 1. Cameron et al. Textbook of Emergency Medicine. Churchill Livingstone Cirak B et al. Spinal injuries in children. J Pediatr Surg. 2004; 39(4): Kuppermann N et al. Identification of children at very low risk of clinicallyimportant brain injuries after head trauma: a prospective cohort study. The Lancet 2009; 374: Dunning J et al. Derivation of the children s head injury algorithm for the prediction of important clinical events decision rule for head injury to children. Arch Dis Child 2006; 91: Brady et al. Queensland Children s Hospital, Queensland Paediatric Trauma Service, Assessment of Possible Cervical Spine Injury in Children Suffering Blunt Trauma. Clinical Guideline 2013.
Paediatric Trauma. A/Prof Drew Richardson. The Canberra Hospital May MB BS (Hons) FACEM Grad CertHE MD
Paediatric Trauma A/Prof Drew Richardson MB BS (Hons) FACEM Grad CertHE MD The Canberra Hospital May 2013 Objectives Identify unique anatomic and physiologic characteristics of injured children Describe
More informationEuropean Resuscitation Council
European Resuscitation Council Incidence of Trauma in Childhood Leading cause of death and disability in children older than one year all over the world Structured approach Primary survey and resuscitation
More informationDaniel A. Beals MD, FACS, FAAP Pediatric Surgery and Urology Community Medical Center Associate Professor of Surgery and Pediatrics University of
Daniel A. Beals MD, FACS, FAAP Pediatric Surgery and Urology Community Medical Center Associate Professor of Surgery and Pediatrics University of Washington Seattle Children s Hospital Objectives Define
More informationITLS Pediatric Provider Course Advanced Pre-Test
ITLS Pediatric Provider Course Advanced Pre-Test 1. You arrive at the scene of a motor vehicle crash and are directed to evaluate a child who was in one of the vehicles. The patient appears to be a child
More informationPediatric Trauma. Sept 2nd, Patrick Murphy Neil Merritt
Pediatric Trauma Sept 2nd, 2015 Patrick Murphy Neil Merritt Objectives Objectives Medical Expert 1. Describe the types of pediatric injuries sustained with a given mode of trauma, and identify the most
More informationPediatric Trauma. July 27 th, Suzana Buac, PGY4. Dr. Neil Merritt
Pediatric Trauma July 27 th, 2016. Suzana Buac, PGY4 Dr. Neil Merritt Case 5yoM fall from roof Fall from roof of home while father was shingling 5yoM fall from roof Fall from roof of home while father
More informationPediatric Trauma Karim Rafaat, MD
Pediatric Trauma Karim Rafaat, MD Goals Time is short I m going to presume you know your basic ATLS (that s that whole ABCD thing, by the way) Discuss each general trauma susceptible region Focus on: Epidemiology
More information10. Severe traumatic brain injury also see flow chart Appendix 5
10. Severe traumatic brain injury also see flow chart Appendix 5 Introduction Severe traumatic brain injury (TBI) is the leading cause of death in children in the UK, accounting for 15% of deaths in 1-15
More informationHead injuries. Severity of head injuries
Head injuries ED Teaching day 23 rd October Severity of head injuries Minor GCS 14-15 Must not have any of the following: Amnesia 10min Neurological sign or symptom Skull fracture (clinically or radiologically)
More informationITLS Pediatric Provider Course Basic Pre-Test
ITLS Pediatric Provider Course Basic Pre-Test 1. You arrive at the scene of a motor vehicle collision and are directed to evaluate a child who was in one of the vehicles. The patient appears to be a child
More informationHead injuries in children. Dr Jason Hort Paediatrician Paediatric Emergency Physician, June 2017 Children s Hospital Westmead
Head injuries in children Dr Jason Hort Paediatrician Paediatric Emergency Physician, June 2017 Children s Hospital Westmead Objectives Approach to minor head injury Child protection issues Concussion
More informationThe ABC s of Chest Trauma
The ABC s of Chest Trauma J Bradley Pickhardt MD, FACS Providence St Patrick Hospital What s the Problem? 2/3 of trauma patients have chest trauma Responsible for 25% of all trauma deaths Most injuries
More information17. Imaging and interventional radiology
17. Imaging and interventional radiology These guidelines have been adapted from the Leeds Major Trauma Centre Imaging in Paediatric Major Trauma guidelines Written by Dr Annmarie Jeanes (Consultant Paediatric
More informationAlgorithms for managing the common trauma patient
ALGORITHMS Algorithms for managing the common trauma patient J John, MB ChB Department of Urology, Frere Hospital, East London Hospital Complex, East London, South Africa Corresponding author: J John (jeffveenajohn@gmail.com)
More informationStandardize comprehensive care of the patient with severe traumatic brain injury
Trauma Center Practice Management Guideline Iowa Methodist Medical Center Des Moines Management of Patients with Severe Traumatic Brain Injury (GCS < 9) ADULT Practice Management Guideline Contact: Trauma
More informationPrinted copies of this document may not be up to date, obtain the most recent version from
Children s Acute Transport Service Clinical Guidelines Septic Shock Document Control Information Author Claire Fraser P.Ramnarayan Author Position tanp CATS Consultant Document Owner E. Polke Document
More informationHEAD INJURY MODULE ASSESSMENT OF HEAD INJURY
HEAD INJURY MODULE Introduction Head injury is common in both adult and paediatric populations. In all-comers with head injury, () 90% present with normal or near-normal consciousness, and mortality is
More informationAcute Neurosurgical Emergency Transfer [see also CATS SOP neurosurgical]
Children s Acute Transport Service Clinical Guidelines Acute Neurosurgical Emergency Transfer [see also CATS SOP neurosurgical] Document Control Information Author D Lutman Author Position Head of Clinical
More informationManagement of Severe Traumatic Brain Injury
Guideline for North Bristol Trust Management of Severe Traumatic Brain Injury This guideline describes the following: Initial assessment and management of the patient with head injury Indications for CT
More information3. D Objective: Chapter 4, Objective 4 Page: 79 Rationale: A carbon dioxide level below 35 mmhg indicates hyperventilation.
1. A Objective: Chapter 1, Objective 3 Page: 14 Rationale: The sudden increase in acceleration produces posterior displacement of the occupants and possible hyperextension of the cervical spine if the
More informationTrauma Life Support Pre-Hospital (TLS-P) Preparatory Materials
Trauma Life Support Pre-Hospital (TLS-P) Preparatory Materials 1 1. A high-risk bodily fluid for spreading infection is blood. 2. Items that can reduce the spread of infection include masks, gloves, and
More informationOverview. Overview. Chapter 30. Injuries to the Head and Spine 9/11/2012. Review of the Nervous and Skeletal Systems. Devices for Immobilization
Chapter 30 Injuries to the Head and Spine Slide 1 Overview Review of the Nervous and Skeletal Systems The Nervous System The Skeletal System Devices for Immobilization Cervical Spine Short Backboards Long
More informationLittle Kids in Big Crashes The Bio-mechanics of Kids in Car Crashes. Lisa Schwing, RN Trauma Program Manager Dayton Children s
Little Kids in Big Crashes The Bio-mechanics of Kids in Car Crashes Lisa Schwing, RN Trauma Program Manager Dayton Children s Very Little Research There has been very little research on the forces a crash
More informationPRACTICE GUIDELINE. DEFINITIONS: Mild head injury: Glasgow Coma Scale* (GCS) score Moderate head injury: GCS 9-12 Severe head injury: GCS 3-8
PRACTICE GUIDELINE Effective Date: 9-1-2012 Manual Reference: Deaconess Trauma Services TITLE: TRAUMATIC BRAIN INJURY GUIDELINE OBJECTIVE: To provide practice management guidelines for traumatic brain
More informationPost Resuscitation (ROSC) Care
Standard Operating Procedure 2.10 Post Resuscitation (ROSC) Care Position Responsible: Medical Director Approved: Clinical Governance Committee Related Documents: This document is the intellectual property
More informationAPPROACH TO TRAUMA. Dr E.Memary Anesthesiologist Assistant Professor of SBMU
APPROACH TO TRAUMA Dr E.Memary Anesthesiologist Assistant Professor of SBMU Objectives Describe the initial approach to the injured patient, including the primary and secondary surveys. Identify the types
More informationMedical NREMT-PTE. NREMT Paramedic Trauma Exam.
Medical NREMT-PTE NREMT Paramedic Trauma Exam https://killexams.com/pass4sure/exam-detail/nremt-pte Question: 41 Which of the following most accurately describes the finding of jugular venous distension
More informationResuscitation Checklist
Resuscitation Checklist Actions if multiple responders are on scene Is resuscitation appropriate? Conditions incompatible with life Advanced decision in place Based on the information available, the senior
More informationATLS: Initial Assessment and Management. SAUSHEC Medical Student Lecture Series
ATLS: Initial Assessment and Management SAUSHEC Medical Student Lecture Series Objectives Identify sequence of priorities in assessing the multiply injured patient Apply principles outlined in primary
More informationPrinted copies of this document may not be up to date, obtain the most recent version from
Children s Acute Transport Service Clinical Guidelines Septic Shock Document Control Information Author Shruti Dholakia L Chigaru Author Position Fellow CATS Consultant Document Owner E. Polke Document
More informationMajor Trauma Scenarios. Ballarat Health Services Emergency Medicine Training Hub
Major Trauma Scenarios Ballarat Health Services Emergency Medicine Training Hub Trauma Scenario 1 You receive a phone call from the ambulance service. They have a 27 yr old male involved in a MCA, he is
More informationEMS System for Metropolitan Oklahoma City and Tulsa 2019 Medical Control Board Treatment Protocols
EMERGENCY MEDICAL RESPONDER EMT EMT-INTERMEDIATE 85 ADVANCED EMT PARAMEDIC 14G PATIENT PRIORITIZATION While each patient will receive the best possible EMS care in a humane and ethical manner, proper patient
More informationChild as a victim of injury. Maciej Dudkiewicz M.D. Ph.D. Dpt of Anaesthesia and Intensive Care Medical University of Lodz
Child as a victim of injury Maciej Dudkiewicz M.D. Ph.D. Dpt of Anaesthesia and Intensive Care Medical University of Lodz Epidemiology Trauma is most common cause of mortality and morbidity in the US pediatric
More information1. In a rear-impact motor vehicle crash, which area of the spine is most susceptible to injury? A. Cervical B. Thoracic C. Lumbar D.
1. In a rear-impact motor vehicle crash, which area of the spine is most susceptible to injury? A. Cervical B. Thoracic C. Lumbar D. Sacral-coccygeal 2. A 36-year-old male sustains blunt force thoracic
More informationEmergency Room Resuscitation of the Unstable Trauma Patient
Emergency Room Resuscitation of the Unstable Trauma Patient Goals of trauma resuscitation Maintain: Systemic oxygenation Systemic perfusion Neurologic function Approach to unstable trauma patient Primary
More informationObjectives. Review ATLS from the pediatric perspective Convince you that children aren t simply little. Impress you with my Power Point mastery
Pediatric Trauma Objectives Review ATLS from the pediatric perspective Convince you that children aren t simply little adults (especially when it comes to trauma) Impress you with my Power Point mastery
More information11. Spinal cord injury
11. Spinal cord injury Introduction Always think spinal (vertebral) and/or spinal cord injury (SCI) in children with trauma. Remember SCIWORA cord injury may be present without abnormalities on routine
More informationTime Equals Neurons - Spinal Cord Injury Management in the first 4 Hours
Time Equals Neurons - Spinal Cord Injury Management in the first 4 Hours William D. Whetstone M.D. Clinical Professor UCSF Department of Emergency Medicine SFGH ED Center for Neuro-Critical Emergencies
More informationRequest Card Task ANSWERS
Request Card Task ANSWERS Medical Student Workbook Author: Dr Sam Leach, SpR Case 1 What differential diagnoses are most likely? Which investigation is most appropriate? Case 1 The most likely diagnosis
More informationPRE-HOSPITAL PATIENT CARE PROTOCOLS BASIC LIFE SUPPORT/ADVANCED LIFE SUPPORT
PRE-HOSPITAL PATIENT CARE PROTOCOLS BASIC LIFE SUPPORT/ADVANCED LIFE SUPPORT Board Approved June 2007 Revised December 2009 Revised July 2011 Revised June 2015 435 Hunter Street Fredericksburg, VA 22401
More informationIn ESH we usually see blunt chest trauma but penetrating injuries also treated here (usually as single injuries, like stab wound)
Chest Trauma Dr Csaba Dioszeghy MD PhD FRCEM FFICM FERC East Surrey Hospital Emergency Department Scope Thoracic injuries are common and can be life threatening In ESH we usually see blunt chest trauma
More informationHead injury in children
Head injury in children Michael Kim, MD Department of Emergency Medicine University of Wisconsin- Madison #1 cause of death and disability Bimodal distribution 62,000 hospitalization 564,000 ED visits
More informationSPINE EVALUATION AND CLEARANCE Basic Principles
SPINE EVALUATION AND CLEARANCE Basic Principles General 1. Entire spine is immobilized during primary survey. 2. Radiographic clearance of the spine is not required before emergent surgical procedures.
More informationSCIWORA Rozlyn McTeer BSN, RN, CEN Pediatric Trauma Coordinator Trauma Services OBJECTIVES DEFINITION 11/8/2017. Identify SCIWORA.
SCIWORA Rozlyn McTeer BSN, RN, CEN Pediatric Trauma Coordinator Trauma Services Identify SCIWORA. OBJECTIVES Identify the population at risk. To identify anatomic and physiologic reasons for SCIWORA. To
More informationAbdomen and Genitalia Injuries. Chapter 28
Abdomen and Genitalia Injuries Chapter 28 Hollow Organs in the Abdominal Cavity Signs of Peritonitis Abdominal pain Tenderness Muscle spasm Diminished bowel sounds Nausea/vomiting Distention Solid Organs
More informationActivity Three: Where s the Bleeding?
Activity Three: Where s the Bleeding? There are five main sites of potentially fatal bleeding in trauma, remembered by the phrase on the floor and four more. On the floor refers to losing blood externally
More informationTraumatic Brain Injuries
Traumatic Brain Injuries Scott P. Sherry, MS, PA-C, FCCM Assistant Professor Department of Surgery Division of Trauma, Critical Care and Acute Care Surgery DISCLOSURES Nothing to disclose Discussion of
More informationAnesthesia for multiple trauma: from the scene to the OR
Anesthesia for multiple trauma: from the scene to the OR Gary Hartstein,, M.D. Service d'anesthésie-réanimationsie-réanimation Service des Urgences CHU Liège B.35 4000 Liège Course outline philosophy of
More information9/29/2014 CHALLENGING PEDIATRIC TRAUMA CASES: PEARLS FOR CARE. Traumatic injuries are the #1 cause of death for age 1-18 years old
CHALLENGING PEDIATRIC TRAUMA CASES: PEARLS FOR CARE UW Medicine EMS & Trauma Conference Jamie Shandro MD MPH Associate Professor, Emergency Medicine Harborview Medical Center September 29, 2014 WHY IS
More informationHEAD INJURY. Dept Neurosurgery
HEAD INJURY Dept Neurosurgery INTRODUCTION PATHOPHYSIOLOGY CLINICAL CLASSIFICATION MANAGEMENT - INVESTIGATIONS - TREATMENT INTRODUCTION Most head injuries are due to an impact between the head and another
More informationCare of the Deteriorating Patient in Recovery NADIA TICEHURST : CLINICAL NURSE EDUCATOR PERI ANAESTHETICS BENDIGO HEALTH
Care of the Deteriorating Patient in Recovery NADIA TICEHURST : CLINICAL NURSE EDUCATOR PERI ANAESTHETICS BENDIGO HEALTH Intended learning outcomes Describe the components of a comprehensive clinician
More informationCHEST INJURY PULMONARY CONTUSION
CHEST INJURY PULMONARY CONTUSION Introduction Pulmonary contusion refers to blunt traumatic lung parenchymal injury which results in oedema and haemorrhaging into alveolar spaces. It may also result in
More informationRCH Trauma Guideline. Management of Traumatic Pneumothorax & Haemothorax. Trauma Service, Division of Surgery
RCH Trauma Guideline Management of Traumatic Pneumothorax & Haemothorax Trauma Service, Division of Surgery Aim To describe safe and competent management of traumatic pneumothorax and haemothorax at RCH.
More informationINTUBATION/RSI. PURPOSE: A. To facilitate secure, definitive control of the airway by endotracheal intubation in an expeditious and safe manner
Manual: LifeLine Patient Care Protocols Section: Adult/Pediatrics Protocol #: AP1-009 Approval Date: 03/01/2018 Effective Date: 03/05/2018 Revision Due Date: 12/01/2018 INTUBATION/RSI PURPOSE: A. To facilitate
More informationPediatric Trauma. Andrea L. Williams, PhD, RN
Pediatric Trauma Andrea L. Williams, PhD, RN Clinical Associate Professor UW School of Nursing Emergency Education Specialist UW Emergency Education Center Why Are Traumatic Injuries Different in Children
More informationITLS Advanced Pre-Test Annotated Key 8 th Edition
1. A Objective: Chapter 1, Objective 3 Page: 14 Rationale: The sudden increase in acceleration produces posterior displacement of the occupants and possible hyperextension of the cervical spine if the
More informationPaediatric Emergency Prompt Cards
Paediatric Emergency Prompt Cards Introduced July 2016 Prompt cards are designed to be used by any member of the resus team If you have any comments or suggestions, please contact helen.collyer-merritt@sash.nhs.uk
More informationPRE-HOSPITAL EMERGENCY CARE COURSE.
PRE-HOSPITAL EMERGENCY CARE COURSE www.basics.org.uk Chest Assessment & Management BASICS Education March 2016 Objectives To understand the importance of oxygenation and ventilation To be able to describe
More informationTRAUMA CHART. SW London & Surrey Trauma Network Trauma Documentation. Trauma Team. Pre-alert details
SW London & Surrey Trauma Network Trauma Documentation Pre-alert details Ambulance Call Sign: Age: Mechanism: Injury: Date: Call received by: Male / Female Time: St George s Hospital East Surrey Hospital
More informationEMS System for Metropolitan Oklahoma City and Tulsa 2018 Medical Control Board Treatment Protocols
EMERGENCY MEDICAL RESPONDER EMT EMT-INTERMEDIATE 85 ADVANCED EMT PARAMEDIC 14G PATIENT PRIORITIZATION While each patient will receive the best possible EMS care in a humane and ethical manner, proper patient
More informationof Trauma Assembly 27 th Page 1
Eastern Association for the Surgery of Trauma 27 th Annual Scientific Assembly Sunrise Session 08 To Scan or Not To Scan Thatt is the Question January 16, 2014 Waldorf Astoria Naples Naples, Floridaa Page
More informationThe immediate management of burns patients should be similar to management of trauma.
CATS Clinical Guideline Burns The National Burn Care Review recommends that children with burns should be treated in a Burn Centre. Chelsea and Westminster may take non-ventilated children, Broomfield
More information2. Blunt abdominal Trauma
Abdominal Trauma 1. Evaluation and management depends on: a. Mechanism (Blunt versus Penetrating) b. Injury complex in addition to abdomen c. Haemodynamic stability assessment: i. Classically patient s
More informationTrauma CT Scanning Protocol
Northern Trauma Network Trauma CT Scanning Protocol Background Whole body CT (WBCT) has assumed a pivotal position in trauma management. UK trauma is typically described as blunt and blind i.e. blunt trauma
More informationMichael Avant, M.D. The Children s Hospital of GHS
Michael Avant, M.D. The Children s Hospital of GHS OVERVIEW ER to ICU Transition Early Management Priorities the First 48 hours Organ System Support Complications THE FIRST 48 HOURS Communication Damage
More informationPediatric Trauma Practice. Guideline for Management of the Child in Shock. Background
Pediatric Trauma Practice Guideline for Management of the Child in Shock Background Guideline for Management Trauma is the leading cause of death in children and adolescents in the United States. Although
More informationPEDIATRIC TRAUMA: Implications for Respiratory Care
PEDIATRIC TRAUMA: Implications for Respiratory Care 17 th Annual Rainbow Respiratory Conference - September 4, 2015 Mike Dingeldein, MD Pediatric Surgeon Pediatric Trauma Medical Director Disclosures none
More informationShenandoah Co. Fire & Rescue. Injuries to. and Spine. December EMS Training Bill Streett Training Section Chief
Shenandoah Co. Fire & Rescue Injuries to the Head and Spine December EMS Training Bill Streett Training Section Chief C.E. Card Information BLS Providers 2 Cards / Provider Category 1 Course # Blank Topic#
More informationIndications for cervical spine immobilisation: -
Paediatric Trauma Cervical Spine Guidelines UHW Traumatic injuries of the cervical spine (C-spine) are uncommon in children. However, it is safer assume there is a cervical spine injury until examination
More informationPARA107 Summary. Page 1-3: Page 4-6: Page 7-10: Page 11-13: Page 14-17: Page 18-21: Page 22-25: Page 26-28: Page 29-33: Page 34-36: Page 37-38:
PARA107 Summary Page 1-3: Page 4-6: Page 7-10: Page 11-13: Page 14-17: Page 18-21: Page 22-25: Page 26-28: Page 29-33: Page 34-36: Page 37-38: Injury, Mechanisms of Injury, Time Critical Guidelines Musculoskeletal
More informationPEDIATRIC TRAUMA EMERGENCIES
PEDIATRIC TRAUMA EMERGENCIES Last Revised: January 2015 1 PEDIATRIC COMA SCALE Indicator Eye Opening Spontaneous 4 To verbal stimuli 3 To pain only 2 No response 1 Verbal Response Oriented, appropriate
More informationImaging in the Trauma Patient
Imaging in the Trauma Patient David A. Spain, MD Department of Surgery Stanford University Pan Scan Instead of Clinical Exam? 1 Granted, some patients don t need CT scan Platinum Package Stanford Special
More informationPatient Assessment. Chapter 8
Patient Assessment Chapter 8 Patient Assessment Scene size-up Initial assessment Focused history and physical exam Vital signs History Detailed physical exam Ongoing assessment Patient Assessment Process
More informationPediatric Patients. BCFPD Paramedic Education Program. EMS Education Paramedic Level
Pediatric Patients BCFPD Program Basic Considerations Much of the initial patient assessment can be done during visual examination of the scene. Involve the caregiver or parent as much as possible. Allow
More informationChapter 32. Objectives. Objectives 01/09/2013. Spinal Column and Spinal Cord Trauma
Chapter 32 Spinal Column and Spinal Cord Trauma Prehospital Emergency Care, Ninth Edition Joseph J. Mistovich Keith J. Karren Copyright 2010 by Pearson Education, Inc. All rights reserved. Objectives 1.
More informationChapter 8 Trauma Patient Assessment The Patient Assessment Process The Primary Assessment ABCDE s Airway, Breathing, Circulation while securing
1 2 3 4 5 6 Chapter 8 Trauma Patient Assessment The Patient Assessment Process The Primary Assessment ABCDE s Airway, Breathing, Circulation while securing D-Disability Chief complaint and/or Mechanism
More informationMichigan Pediatric Cardiac Protocols. Date: November 15, 2012 Page 1 of 1 TABLE OF CONTENTS
Date: November 15, 2012 Page 1 of 1 TABLE OF CONTENTS Pediatric Asystole Section 4-1 Pediatric Bradycardia Section 4-2 Pediatric Cardiac Arrest General Section 4-3 Pediatric Narrow Complex Tachycardia
More informationCORE STANDARDS STANDARDS USED IN TARN REPORTS
CORE STANDARDS Time to CT Scan BEST PRACTICE TARIFF SECTION 4.10 MAJOR TRAUMA 7 If the patient is admitted directly to the MTC or transferred as an emergency, the patient must be received by a trauma team
More informationChapter 39 Trauma in the Elderly
Chapter 39 Trauma in the Elderly Episode Overview 1) 5 Risk Factors for falls in the elderly? 2) What anatomic and physiologic changes in the elderly patient are important for the management of trauma
More informationPediatric Trauma Cases
Pediatric Trauma Cases QPEM 2018 Barbara Blackie, MD, MEd, FRCPC DISCLOSURE I do not have any relevant financial relationship with commercial interest to disclose. Learning Objectives -Manage interactive
More informationICU treatment of the trauma patient. Intensive Care Training Program Radboud University Medical Centre Nijmegen
ICU treatment of the trauma patient Intensive Care Training Program Radboud University Medical Centre Nijmegen Christian Kleber Surgical Intensive Care Unit - The trauma surgery Perspective Langenbecks
More informationOctober Paediatric Respiratory Workbook APCP RESPIRATORY COMMITTEE
October 2017 Paediatric Respiratory Workbook APCP RESPIRATORY COMMITTEE This workbook is designed to introduce to you the difference between paediatric and adult anatomy and physiology. It will also give
More informationLOSS OF CONSCIOUSNESS & ASSESSMENT. Sheba Medical Center Acute Medicine Department MATTHEW WRIGHT
LOSS OF CONSCIOUSNESS & ASSESSMENT Sheba Medical Center Acute Medicine Department MATTHEW WRIGHT OUTLINE Causes Head Injury Clinical Features Complications Rapid Assessment Glasgow Coma Scale Classification
More informationIntroduction to Emergency Medical Care 1
Introduction to Emergency Medical Care 1 OBJECTIVES 31.1 Define key terms introduced in this chapter. Slides 13 15, 17, 19, 28 31.2 Describe the components and function of the nervous system and the anatomy
More informationBODY SYSTEMS BODY CAVITIES THE RESPIRATORY SYSTEM. Movements BODY CAVITIES. Pediatric Considerations In Respiratory System
BODY SYSTEMS A body system is a group of organs and other structures work together to carry out specific functions. The following systems work together to carry out a function needed for life: Respiratory
More informationMcHenry Western Lake County EMS System Paramedic, EMT-B and PHRN Optional Continuing Education 2019 #3 Penetrating Neck Trauma
McHenry Western Lake County EMS System Paramedic, EMT-B and PHRN Optional Continuing Education 2019 #3 Penetrating Neck Trauma Penetrating neck injury (PNI) comprises 5 to 10 percent of traumatic injuries
More informationHaemodynamic deterioration in lateral compression pelvic fracture after prehospital pelvic circumferential compression device application
Haemodynamic deterioration in lateral compression pelvic fracture after prehospital pelvic circumferential compression device application Authors Alan A Garner Retrieval consultant CareFlight Northmead,
More informationPediatric Trauma Care
2013 Standard Trauma Care Procedures (Pediatric) Traumatic injuries require prompt care and transportation. Always suspect cervical injury. Note the mechanism of injury and any other condition that may
More informationAcute spinal cord injury
Acute spinal cord injury Thakul Oearsakul Songklanagarind hospital Hat Yai Songkhla Introduction New SCI 10000-12000 cases Approximately 4.0-5.3 per 100000 population Common causes of traumatic SCI :Motor
More informationRhonda Dixon, DVM Section Head, Emergency and Critical Care Sugar Land Veterinary Specialty and Emergency
Rhonda Dixon, DVM Section Head, Emergency and Critical Care Sugar Land Veterinary Specialty and Emergency Traumatic Brain Injury Causes Pathophysiology Neurologic assessment Therapeutic Approach Status
More informationAggressive Management of Chest Trauma. James Moore Cardiothoracic Anaesthetist & Intensive Care Specialist CCDHB
Aggressive Management of Chest Trauma James Moore Cardiothoracic Anaesthetist & Intensive Care Specialist CCDHB Outline Why is chest trauma important? Risk Assessment Which patients can go home? Management
More informationPediatric Shock. Hypovolemia. Sepsis. Most common cause of pediatric shock Small blood volumes (80cc/kg)
Critical Concepts: Shock Inadequate peripheral perfusion where oxygen delivery does not meet metabolic demand Adult vs Pediatric Shock - Same causes/different frequencies Pediatric Shock Hypovolemia Most
More informationTALK TRAUMA Clearing the C-Spine. David Ouellette
TALK TRAUMA 2011 Clearing the C-Spine David Ouellette Case #1 - Mother / Daughter MVC 34 y/o female Dangerous mechanism CHI Mumbling incoherently Femur # - distracting injury ETOH - 22 9 y/o female Dangerous
More informationInjuries to the Head and Spine
Injuries to the Head and Spine Anatomy Review Skull Protects the brain Made up of several bones with seam like sutures Regions of the scalp-frontal, occipital, parietal, temporal Bones of face Orbits Mandible
More informationSpinal Cord Injuries: The Basics. Kadre Sneddon POS Rounds October 1, 2003
Spinal Cord Injuries: The Basics Kadre Sneddon POS Rounds October 1, 2003 Anatomy Dorsal columntouch, vibration Corticospinal tract- UMN Anterior horn-lmn Spinothalamic tractpain, temperature (contralateral)
More informationPan Scan Instead of Clinical Exam? David A. Spain, MD
Pan Scan Instead of Clinical Exam? David A. Spain, MD Granted, some patients don t t need CT scan Platinum Package Stanford Special CT Scan Head Neck Chest Abdomen Pelvis Takes about 20 minutes to do
More informationAdvanced Life Support
Standard Operating Procedure 2.1 Advanced Life Support Position Responsible: Head of Operations CGC Approved: October 2017 Related Documents Further Information 1.0 Background Magpas Resuscitation Policy
More informationThe Pediatric Patient. Morgen Bernius, MD NCEMS Conference February 24, 2007
The Pediatric Patient Morgen Bernius, MD NCEMS Conference February 24, 2007 Rule #1: Everyone Loves the Pediatric Patient Pediatrics in EMS Approximately 10% of all EMS treatment is for children younger
More informationSurgical Care at the District Hospital. EMERGENCY & ESSENTIAL SURGICAL CARE
Surgical Care at the District Hospital 1 13 Resuscitation and Preparation for Anesthesia & Surgery Key Points 2 13.1 Management of Emergencies and Cardiopulmonary Resuscitation The emergency measures that
More informationTrauma. Neck trauma zones. Neck Injuries 1/3/2018. Basic principles A ; Airway B ; Breathing C ; Circulation D ; Disability E ; Exposure
Trauma 45 minutes highest points Ahmed Mahmoud, MD Basic principles A ; Airway B ; Breathing C ; Circulation D ; Disability E ; Exposure Neck trauma zones Airway ;Rapid sequence intubation Breathing ;Needle
More information