Pediatric Trauma and Injury

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Questions and Answers

What percentage of deaths in children under 18 years old are caused by trauma?

20%

50%

30%

40% (correct)

What type of trauma is caused by gunshot wounds and stabbings?

Blunt trauma

Hypothermic trauma

Burn trauma

Penetrating trauma (correct)

What is a common complication of pediatric trauma?

Hypertension

Hypothyroidism

Hyperthermia

Hypovolemic shock (correct)

What is the primary focus of the primary survey in pediatric trauma assessment?

Airway, breathing, and circulation Signup and view all the answers

What is a common psychological complication of pediatric trauma?

Acute stress disorder Signup and view all the answers

What type of care is essential in pediatric trauma?

Family-centered care Signup and view all the answers

What type of trauma requires a high index of suspicion and specialized evaluation?

Non-accidental trauma Signup and view all the answers

What is used to diagnose injuries in pediatric trauma patients?

Imaging studies Signup and view all the answers

What is a potential detrimental effect of administering analgesia to patients in severe hypotension or decompensated shock?

Blunting of the stress response Signup and view all the answers

What is a potential psychological adverse effect of unmanaged pain?

Sleep deprivation Signup and view all the answers

What is a potential cardiovascular adverse effect of unmanaged pain?

Increased myocardial oxygen demand Signup and view all the answers

What is the primary focus of pre-hospital analgesia?

Hastening the relief of discomfort Signup and view all the answers

What is a potential gastrointestinal adverse effect of unmanaged pain?

Decreased bowel motility Signup and view all the answers

What is a potential musculoskeletal adverse effect of unmanaged pain?

Spasms and impaired muscle function Signup and view all the answers

What is a potential neuroendocrine adverse effect of unmanaged pain?

Activation of the stress response Signup and view all the answers

What is a potential respiratory adverse effect of unmanaged pain?

Decreased lung volumes Signup and view all the answers

What is a common challenge in pre-hospital pain management?

Limited availability of appropriate treatment options Signup and view all the answers

What is a potential benefit of pre-hospital analgesia?

Hastening the relief of discomfort Signup and view all the answers

Study Notes

Definition and Epidemiology

Trauma is a leading cause of morbidity and mortality in pediatric patients
Accounts for 40% of deaths in children under 18 years old
In the US, approximately 10,000 children die and 100,000 are hospitalized annually due to traumatic injuries

Types of Trauma in Pediatrics

Blunt trauma: most common type, caused by falls, motor vehicle accidents, and assault
Penetrating trauma: caused by gunshot wounds, stabbings, and other piercing injuries
Burn trauma: caused by thermal, electrical, or chemical burns

Physiological Response to Trauma in Children

Hypovolemic shock: common in pediatric trauma, caused by blood loss and dehydration
Hypothermia: common in pediatric trauma, caused by environmental exposure and blood loss
Metabolic acidosis: caused by tissue hypoperfusion and anaerobic metabolism

Assessment and Management

Primary survey: focuses on airway, breathing, and circulation (ABCs)
Secondary survey: comprehensive physical examination to identify all injuries
Imaging studies: used to diagnose injuries, including X-rays, CT scans, and ultrasounds
Fluid resuscitation: used to treat hypovolemic shock
Pain management: crucial in pediatric trauma, often using multimodal analgesia

Psychological Trauma in Pediatrics

Acute stress disorder: common in pediatric trauma, characterized by symptoms of dissociation and anxiety
Post-traumatic stress disorder (PTSD): can develop in pediatric trauma patients, especially those with a history of prior trauma
Psychological support: crucial in pediatric trauma, including counseling and therapy

Special Considerations in Pediatric Trauma

Non-accidental trauma (NAT): also known as child abuse, requires a high index of suspicion and specialized evaluation
Trauma in special populations: pediatric patients with pre-existing medical conditions, such as congenital heart disease or developmental disabilities, require tailored care
Family-centered care: essential in pediatric trauma, including support and counseling for families

Trauma in Pediatrics

Trauma is a leading cause of morbidity and mortality in pediatric patients, accounting for 40% of deaths in children under 18 years old.
In the US, approximately 10,000 children die and 100,000 are hospitalized annually due to traumatic injuries.

Types of Trauma

Blunt trauma is the most common type, caused by falls, motor vehicle accidents, and assault.
Penetrating trauma is caused by gunshot wounds, stabbings, and other piercing injuries.
Burn trauma is caused by thermal, electrical, or chemical burns.

Physiological Response to Trauma

Hypovolemic shock is common in pediatric trauma, caused by blood loss and dehydration.
Hypothermia is common in pediatric trauma, caused by environmental exposure and blood loss.
Metabolic acidosis is caused by tissue hypoperfusion and anaerobic metabolism.

Trauma Assessment and Management

Primary survey focuses on airway, breathing, and circulation (ABCs).
Secondary survey is a comprehensive physical examination to identify all injuries.
Imaging studies are used to diagnose injuries, including X-rays, CT scans, and ultrasounds.
Fluid resuscitation is used to treat hypovolemic shock.
Pain management is crucial in pediatric trauma, often using multimodal analgesia.

Psychological Trauma

Acute stress disorder is common in pediatric trauma, characterized by symptoms of dissociation and anxiety.
Post-traumatic stress disorder (PTSD) can develop in pediatric trauma patients, especially those with a history of prior trauma.
Psychological support is crucial in pediatric trauma, including counseling and therapy.

Special Considerations

Non-accidental trauma (NAT) requires a high index of suspicion and specialized evaluation.
Pediatric patients with pre-existing medical conditions require tailored care.
Family-centered care is essential in pediatric trauma, including support and counseling for families.

Pain Management

All patients should be reassessed at frequent intervals using a standardized age-appropriate pain scale.
Redosing should be done if pain persists, but only if:
- There is an increase in pain score.
- Pain is likely to occur due to unavoidable movement (extrication).
- The half-life of medication is reached and the effect starts to reduce.
- Aliquots were used with initial administration and the full dose has not yet been administered (titrating to effect).

Importance of Pre-Hospital Analgesia

Safely and effectively relieves suffering.
Prompt analgesia might prevent long-term adverse effects, especially in very young children.
Impacts on mood and mental health.
Impacts on sleep.
Impacts on cardiovascular health.
Impacts on cognitive processes, brain function, and CNS.
Impacts on sexual function.
Impacts on quality of life and functionality.
Mitigates elevations in heart rate and blood pressure that accompany pain.
Might be misconstrued as another clinical process.
Might impact negatively on certain disease processes, such as myocardial ischemia and head injury.
Might improve clinical status by facilitating respiratory effort and increasing oxygenation (e.g., chest wall injuries, multiple rib fractures, or flail chest).
Patient is overall easier to manage.

Pre-Hospital Analgesia in Trauma

The management of acute traumatic pain is a crucial component of pre-hospital care.
The assessment and administration of analgesia is highly variable, frequently suboptimal, and often determined by consensus-based protocols.
All patients with acute traumatic pain should be considered candidates for analgesia, regardless of transport interval.
Reassess all patients who have received analgesia using an age-appropriate scale every 5 minutes.

Types of Pain

Chronic pain: long-lasting and usually does not reduce with most treatments (e.g., osteoarthritis or fibromyalgia).
Acute pain: occurs suddenly but is temporary, associated with anxiety and emotional stress, and resolves as the injury heals (e.g., fracture).
Nociceptive pain: due to an injury to the body tissue (skin, muscle, or bone), pain reduces once the injury heals.
- Somatic: sharp, stabbing, well-localized to area of injury (e.g., skin, muscles, soft tissues).
- Visceral: dull, heavy, aching pain over a wide area (e.g., internal organs).
Neuropathic pain: due to dysfunction or damage to the nerves, spinal cord, or brain, characterized by a burning, tingling, or stabbing sensation.
- Peripheral.
- Central.
Psychogenic pain: caused by psychological factors, physical pain due to tissue or nerve damage but increases and is prolonged because of stress, fear, anxiety, or depression.
Inflammatory pain: caused by an inappropriate response from the immune system (e.g., gout or rheumatoid arthritis).

Adverse Effects of Pain

Neuroendocrine:
- Activation of stress response.
- Poor wound healing.
- Impaired immune function.
- Hyperglycaemia.
- Weight loss / muscle wasting.
Musculoskeletal:
- Spasms.
- Impaired muscle mobility and function.
- Immobility.
- Weakness.
- Fatigue.
Psychological:
- Anxiety.
- Fear.
- Sleep deprivation.
- PTSD.
Cardiovascular:
- ↑ heart rate.
- ↑ blood pressure.
- ↑ myocardial oxygen demand.
- Hypercoagulation.
- Unstable angina.
- Myocardial infarction.
- Deep vein thrombosis.
- Pulmonary embolism.
Respiratory:
- ↓ lung volumes.
- ↓ cough.
- Splinting.
- Pneumonia.
- Hypoxaemia.
- Atelectasis.
Gastrointestinal:
- ↓ bowel motility.
- ↓ gastric emptying.
- Constipation.
- Anorexia.

Pre-Hospital Analgesia

Hastens the relief of discomfort rather than waiting for pain medication administration in EDs.
Pain management is frequently based on the assessment of need by a provider, rather than the requirements of patients.
Historically, only entonox and morphine have been available for pre-hospital pain management.
Many new additions, such as Ketamine, are available.
The availability of appropriate and effective treatment options remains a challenge.

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Description

This quiz covers the definition and epidemiology of trauma in pediatric patients, including types of trauma and associated statistics.