Trauma and Burns

Questions and Answers

What is the leading cause of death from injury among pediatric trauma victims?

Burn injuries

Traumatic brain injury (correct)

Fractures

Drowning

What is the relationship between systemic blood pressure (SBP) and mortality in children with TBI?

SBP is unrelated to mortality rates

Higher SBP leads to increased mortality

Lower SBP increases mortality risk (correct)

SBP only affects adults, not children

Which of the following injuries is most concerning for potential child abuse?

Forearm fractures from falling

Eye contusions (correct)

Bumps on the forehead

Bruises on the shins

When does hypotension typically present in children following blood loss?

After a 25% blood volume loss Signup and view all the answers

What is the approximate typical blood volume for a child in mL/kg?

80 mL/kg Signup and view all the answers

Which of the following best indicates a concerning sign of hypovolemia in children?

Tachycardia Signup and view all the answers

Which age group has the highest rate of fatalities due to child abuse in the U.S.?

Children younger than 1 year Signup and view all the answers

What key factor must be determined to protect a child presenting with trauma?

Accidental or intentional injury Signup and view all the answers

What Glasgow Coma Score (GCS) indicates the need for intubation?

8 or lower Signup and view all the answers

Which intervention should take precedence in a patient with a low GCS?

Airway management Signup and view all the answers

What percentage of Total Body Surface Area (TBSA) burned indicates that intubation should be strongly considered?

30%–40% Signup and view all the answers

Which formula is commonly used to estimate fluid needs over the first 24 hours after a burn?

Parkland formula Signup and view all the answers

What is a major risk associated with inhalational injury in fires in enclosed spaces?

Asphyxiation due to oxygen consumption Signup and view all the answers

What initial treatment should be considered in suspected cyanide poisoning from fires?

Sodium thiosulfate Signup and view all the answers

What is the cause of tissue hypoxia in carbon monoxide poisoning?

Binding of carbon monoxide to hemoglobin Signup and view all the answers

Which of the following is a sign of true inhalational injury?

Facial burns Signup and view all the answers

What fluid replacement formula is less commonly used in children compared to the Parkland formula?

Brooke formula Signup and view all the answers

How is pulse oximetry affected in cases of carbon monoxide poisoning?

It provides falsely elevated saturation readings Signup and view all the answers

What is the most common type of burn in children?

Scalds Signup and view all the answers

Which age group has the head representing a larger percentage of TBSA?

Children aged 1-4 Signup and view all the answers

What leads to upregulation of acetylcholine receptors after a burn injury?

Burn injuries themselves Signup and view all the answers

Which of the following is a sign that nonaccidental scald burns might be suspected?

Inconsistent story with the injury Signup and view all the answers

Which type of burn is the second most common in children?

Contact burns Signup and view all the answers

What is the primary reason for needing a warmer operating room for burn patients?

To reduce cutaneous heat loss Signup and view all the answers

What is a potential complication of eschars formed over full-thickness burns?

Abdominal compartment syndrome Signup and view all the answers

Why is intraosseous (IO) access preferred in acute trauma settings?

Peripheral IV access may be difficult or impossible Signup and view all the answers

What should be avoided from 24-48 hours after a burn injury with regards to succinylcholine?

Its use due to altered muscle receptors Signup and view all the answers

What role does body surface area play in thermal regulation for burn patients?

It determines the rate of cutaneous heat loss Signup and view all the answers

What do the five P's indicating the need for an emergent escharotomy include?

Pain, pallor, paresthesia, paralysis, pulselessness Signup and view all the answers

Which patient demographic is most likely to experience drowning incidents?

Children aged 1 to 4 and adolescents aged 15 to 19 Signup and view all the answers

Which type of burn accounts for the least percentage in children?

Burns due to open flames Signup and view all the answers

What is the critical initial step in managing a drowning victim?

Initiating CPR without delay Signup and view all the answers

What is a recommended method for burn prevention in the home?

Turning pan handles inward Signup and view all the answers

What consequence can occur due to pulmonary aspiration in drowning victims?

Ventilation-perfusion mismatch and shunting Signup and view all the answers

What temperature range characterizes mild hypothermia in drowning patients?

34°C–36°C Signup and view all the answers

What factor primarily increases risk during general anesthesia in burn patients?

Inability to regulate temperature Signup and view all the answers

What is the typical IO access site for children?

Anteromedial surface of the proximal tibia Signup and view all the answers

What is not an indicator for bronchoalveolar lavage in a patient with acute respiratory distress?

To improve oxygenation Signup and view all the answers

What is the most common cause of coagulopathy associated with massive transfusion?

Decreased platelets Signup and view all the answers

Which age group has the highest incidence of traumatic mortality due to motor vehicle accidents?

Children aged 15 to 19 years Signup and view all the answers

What typical complications arise from massive blood transfusions?

Hypocalcemia and hyperkalemia Signup and view all the answers

Why are rib fractures in children considered suspicious for abuse when they occur?

Children have a cartilaginous chest framework Signup and view all the answers

What is the leading cause of traumatic death in children under 1 year of age?

Child abuse Signup and view all the answers

Which of the following factors primarily leads to increased risk of hypothermia during resuscitation in trauma victims?

Massive blood transfusion Signup and view all the answers

What anatomical feature makes cervical spine injuries less common in children compared to adults?

More cartilaginous spine Signup and view all the answers

In pediatric trauma, what is a common finding that may mimic a true cervical spine injury?

Pseudosubluxation Signup and view all the answers

What is the most common type of trauma experienced by children?

Blunt trauma Signup and view all the answers

What condition may occur in up to 50% of children with spinal cord injuries?

Spinal cord injury without radiographic abnormality (SCIWORA) Signup and view all the answers

What is the primary reason prevention is emphasized for reducing drowning incidents in residential pools?

To effectively reduce drowning incidents Signup and view all the answers

Why are partial-thickness burns typically more painful than full-thickness burns?

More nerve endings remain intact in partial-thickness burns Signup and view all the answers

What is a potential advantage of using methadone in burn patients?

It decreases hyperalgesia and minimizes opioid tolerance Signup and view all the answers

What is the role of anxiolytics in pain management for burn patients?

To manage psychological stress Signup and view all the answers

What is the primary reason for the increased metabolic rate in burn patients?

Hypermetabolic state during recovery Signup and view all the answers

How does enteral feeding benefit burn patients?

It maintains GI motility and protects mucosal integrity Signup and view all the answers

What is a potential consequence of not meeting protein requirements in children after a burn?

Delayed wound healing Signup and view all the answers

Why are postpyloric feeding tubes preferred for continuous feeding in large burn patients?

They help meet caloric requirements and provide enteral feeding benefits Signup and view all the answers

What effect does a severe burn have on resting temperature and heart rate?

Increased resting temperature and refractory tachycardia Signup and view all the answers

What is the initial phase of burn injury characterized by during the first 48 hours?

Protein loss and hypovolemia Signup and view all the answers

Study Notes

Traumatic Brain Injury (TBI)

TBI is the leading cause of death (60%-70%) and long-term disability resulting from trauma in all ages.
Maintaining systemic blood pressure (SBP) is critical; children with SBP less than 90 mm Hg have three times higher mortality.
Over 90% of children present with SBP above 90 mm Hg.

Child Abuse and Trauma

Over 3 million child abuse reports filed annually in the U.S.; actual cases may be higher.
Distinction necessary between accidental trauma (e.g., forearm fractures, playground falls) and intentional injuries that raise suspicion for abuse (e.g., rib fractures, skull fractures).
Majority of child abuse fatalities occur in children aged 3 and younger.

Hypotension and Blood Loss in Children

Hypotension due to hypovolemia in children indicates potential cardiovascular collapse.
Children can maintain blood pressure longer than adults after blood loss; tachycardia is an early indicator of blood loss.
Hypotension typically does not manifest until 25% of blood volume is lost; children have a typical blood volume of 80 mL/kg.

Coagulopathy and Massive Transfusion

Massive transfusion can cause coagulopathy due to dilution of clotting factors; hypothermia complicates clotting ability.
Massive blood loss typically results from solid organ injuries; massive exsanguination is uncommon.

Pediatric Trauma Statistics

Trauma is the leading cause of death in children over 1 year, primarily from motor vehicle accidents, followed by falls and child abuse.
Drowning ranks second in injury-related deaths among children; more prevalent in males and typically happens close to home.

Burns in Children

Scalds account for 60%-70% of pediatric burns; contact burns follow at 20%.
Intentional scald burns can be suspected with inconsistent injury stories or specific burn characteristics.
Effective prevention strategies include educating families about kitchen safety and water heater temperatures.

Pain Management in Burn Patients

Pain management is crucial due to the frequency of painful procedures (e.g., dressing changes, debridement).
Partial-thickness burns are generally more painful than full-thickness burns due to intact nerve endings.
Methadone and ketamine can be effective in managing burn-associated hyperalgesia.

Hypermetabolic State after Burns

Burn injuries lead to a hypermetabolic state, particularly in patients with burns covering 60% or more of total body surface area (TBSA).
Acute phase lasts 48 hours post-injury, marked by hypovolemia and protein loss; hypermetabolic phase follows.
Increased metabolic rate involves elevated catecholamines, glucagon, and glucocorticoids which impact healing negatively.

Fluid Resuscitation and Burn Management

Parkland formula estimates fluid needs post-burn, guiding administration of crystalloids.
Over-resuscitation can occur; urine output should be monitored to ensure adequate organ perfusion.

Trauma Assessment Tools

Glasgow Coma Scale (GCS) of 8 or less necessitates intubation due to compromised neurologic status.
True inhalational injuries can carry high morbidity and mortality, particularly in enclosed spaces.
Endotracheal intubation should be considered in cases of significant burn surface area or suspected inhalational injury.

Specific Trauma Considerations

Tension pneumothorax risk is higher in children, requiring prompt needle decompression in certain situations.
Eschar formation over burned skin can compromise vascularity and lead to respiratory complications.

Additional Considerations

Carbon monoxide poisoning may present as falsely elevated pulse oximetry readings and requires specific detection methods (co-oximetry).
Cyanide exposure may occur with combustion, leading to lactic acidosis; sodium thiosulfate can be a treatment option.
Pediatric patients need specialized protocols for injuries due to unique anatomical and physiological differences.### Patient Care and Nutritional Support
Environmental temperatures between 28°C and 33°C can lower caloric demands in patients.
Proper covering during transport, along with analgesics and anxiolytics, contributes to reduced energy needs.

Importance of Enteral Feeding

Enteral feeding is essential for:
- Promoting good nutrition.
- Maintaining gastrointestinal (GI) motility.
- Protecting mucosal integrity to minimize infection and sepsis risk.
- Reducing the incidence of stress ulcers.

Feeding Tube Preferences

Postpyloric feeding tubes are preferred for continuous feeding, particularly in burn patients, to effectively meet caloric needs and provide additional enteral feeding benefits.

Parenteral Feeding Considerations

Parenteral feeding is a viable option but does not maintain the mucosal barrier of the gut.
Increased risk of bacterial translocation and infection is associated with parenteral feeding methods.

Protein Requirements After Burns

Children recovering from burns require approximately 3 grams of protein per kilogram of body weight per day.

Hypothermia Classification

Hypothermia severity is categorized by core body temperature:
- Mild: 34°C to 36°C
- Moderate: 30°C to 34°C
- Severe: Below 30°C

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Description

This quiz explores the critical aspects of traumatic brain injury (TBI) and its implications for pediatric patients. It covers the statistics, treatment approaches, and the importance of systemic blood pressure management in improving outcomes for children with TBI. Test your knowledge and understanding of this crucial health issue.