10 Trauma

Head Trauma

Epidural

• strike to head: ball sports, skiing

• walk, talk, die; loc

• lens shaped hematoma

Subdural

• path: kids brain full in skull. Takes a lot to shear bridging veins. Falling out of crib not enough force. < 3 = abuse

• symptoms:

  • pedestrian struck: hit shoulder, fly

  • MVA: thrown from vehicle

  • shaking baby syndrome

• symptoms: Loc, in coma, stay in coma

• diagnosis: CT crescent shaped.,

Cerebral Contusion

• path: deceleration injury. Brain stops too quick. Coup/contracoup. Sport injury, footbal

• symptoms: loc

• CT: punctate hemorrhage, intraparenchymal

Prevention

• car safety

  • rear facing car seats in back, 0-2 yo

  • booster seats, 4'9", 8-12

  • seat belt: everyone

• Helmets

  • any sports

• trampolines: get rid

Concussion

Contusion:

• path: deceleration injury. Brain stops too quick. Coup/contracoup. Sport injury, footbal

• symptoms: loc

• diagnosis: CT punctate hemorrhage, intraparenchymal

Concussion:

• path: head trauma

• pt: sports injury

• diagnosis: no bleed on CT

2 types:

	Mild	Severe
Focal neurological deficits	x	Yes
Loss of consciousness	< 60 s	> 60 s
Headache	x, or better	yes, worsening (NV)
Amnesia	x	retrograde, anterograde

• Mild: No CT scan, no treatment. Go home and monitor

• Severe: CT scan ruleout brain bleed, admit

• Both: return to play in step wise fashion, from sleeping, doing nothing, to leave house, to contact sports

Drowning

• pt: poor swimmers

  • too young

  • too drunk

• tubs, pools, buckets

• flotation

  • floaties are bad. Keep only arms on top

  • use lifejackets

• prevent: limit access (gates, fences) supervision (lifeguards, parental)

• salt water drowning worse than freshwater drowning: pulmonary edema

• cold water worse than warm water: hypothermia

Pediatric Burns

• Parkland fluid

  • 50% giving in first 8hrs

  • 50% giving in next 16 hrs

  • Calculate % body surface area burned. Only include 2nd and 3rd degree burns

    • % BSA 4 kg

• Kids: body bigger

  • heads: 9 (18 total)

  • chest and abd: each 9, front and back (36 total)

  • Arm: front and back combined 9 (18 total)

  • legs: 3 9's front and back combined

  • genitalia: 1

  • Total: 100%

  

Gun and Chemicals

• Gun

  • eliminate

  • gun/chemical: up high, out of reach

  • gun lock

  • weapons separate from ammo