What is Emergency Medicine - How does permissive hypotension affect damaged kids?
A contentious principle of damage control resuscitation in adults is permissive hypotension. There is no evidence in favor of using permissive hypotension in kids. Children in compensated shock, on the other hand, should have their volume expanded with 10–40 mL/kg of crystalloid until blood products are available.
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What is Emergency Medicine - How should children be dosed for pRBCs, plasma, platelets, cryoprecipitate, and TXA?
TXA 12 years: 15 mg/kg over 10 minutes within 3 hours; then, 2 mg/kg/h over 8 hours. TXA equal to or greater than 12 years: 1 g over 10 minutes within 3 hours; then, 1 g over 8 hours. pRBCs: 10 mL/kg; plasma: 10 mL/kg; platelets: 10 mL/kg; and cryoprecipitate: 10 mL/kg. What is Emergency Medicine - What is tranexamic acid (TXA) and should it be administered to pediatric trauma patients to stop bleeding?
TXA suppresses plasminogen, which prevents clot disintegration and, ultimately, controls hemorrhage. Children with persistent severe bleeding have a lower mortality rate according to preliminary data for TXA, which should ideally be guided by TEG results. What is Emergency Medicine - When should a child injured in an accident have a massive transfusion protocol (MTP) initiated? What ratio of blood products should be applied?
The scant research on pediatric trauma suggests starting MTP once 40 mL/kg of blood product has been transfused or is anticipated to be. Although the ideal blood product proportion for children is uncertain, a 1:1:1 or 1:1:2 ratio of packed red blood cells (pRBCs), platelets, and plasma is suitable. Utilizing plasma, platelets, cryoprecipitate, and pRBCs to target certain coagulation abnormalities, thromboelastography (TEG), a whole blood measurement of clot formation under physiological settings, enables a goal-directed approach to the management of acute traumatic coagulopathy. If a TEG-based transfusion approach is available, it may also be taken into account as a fixed ratio MTP substitute. What is Emergency Medicine - In cases of pediatric traumatic arrest, what is the survival rate following ED thoracotomy?
For children penetrating thoracic trauma, the survival rate following emergency department thoracotomy is 14%, which is comparable to adult survival rates. There are no known survivors of ED thoracotomy in children younger than 15 years old, despite the fact that the survival rate for 15 to 18-year-olds who receive thoracotomy mirrors that of adults at 1% to 2% in the case of blunt trauma. Withholding ED thoracotomy for children under 15 who have suffered blunt trauma and show no indications of life should be taken into consideration. What is Emergency Medicine - On the pediatric FAST exam, where is free fluid most likely to be located?
followed by the right upper quadrant in the pelvis. What is Emergency Medicine - Does the FAST test aid in the identification or treatment of pediatric trauma?
It is not recommended to utilize the focused assessment with sonography for trauma (FAST) alone to check for intraabdominal injury (IAI) in kids or adults. With reported sensitivities ranging from 20% to 80% and specificities of 80%-95%, FAST is less accurate in youngsters than in adults. In the evaluation of a child who is unstable after trauma, FAST (or, more precisely, extended FAST [E-FAST], which also includes evaluation for pneumothorax) is still advised. It may also be taken into account in the evaluation of a patient who is stable together with other clinical criteria. What is Emergency Medicine - What anatomical and physiological variations exist between kids and adults that should be taken into account while treating a youngster who has been injured?
The following anatomic and physiologic changes should be recognized, even though the initial examination and simultaneous stabilization of injured children does not differ from adults: Airway • The pediatric glottis is high and anterior, and the prominent occiput causes neck flexion. Elevate the shoulders and back with a towel roll or stack of sheets to align the oral, pharyngeal, and laryngeal axes and maintain a neutral spine. • The cricothyroid membrane in young children is too small for an open cricothyrotomy; needle cricothyrotomy is advised for infants and children after Breathing • During pediatric intubation, high oxygen consumption rates and poor physiologic reserve result in brief safe apnea intervals and abrupt desaturation; apneic oxygenation can treat hypoxemia at the following age-based flow rates: • 4 L for less than two years; 6 L for two years or more but not more than twelve years; and 8 L for more than twelve years. Children frequently sustain pulmonary contusions without rib fractures due to their flexible chest walls. • Nasogastric or orogastric tube placement should be done as quickly as feasible to prevent ventilation from being compromised by gastric insufflation with bag-valve-mask ventilation. Circulation • Do not rely just on hypotension to diagnose shock; compensatory mechanisms (tachycardia and vasoconstriction) may keep blood pressure stable in pediatric trauma patients until loss of roughly 40% of blood volume. At that point, decompensation occurs quickly. • There have never been any documented cases of children under the age of 15 who underwent an emergency department thoracotomy after suffering a blunt traumatic arrest. • If peripheral intravenous (IV) placement fails, the anterior tibia, followed by the distal femur, and the medial malleolus are the recommended locations for interosseous access in children. Disability • After suffering a serious head injury, young children with open sutures and big fontanelles may have delayed indications of elevated intracranial pressure. • To determine the mental state of preverbal children, use the pediatric Glasgow Coma Scale (GCS) score or the AVPU (alert, verbal, painful, unresponsive) scale. An AVPU score of V or higher corresponds to a GCS score of at least 9. Children under the age of eight are more vulnerable to upper cervical spine injuries because of their comparatively large heads and high cervical fulcrum. As a result of horizontally positioned facet joints, inadequate spinal ossification, and immature ligamentous support structures, ligamentous cervical injuries without fracture are frequent in youngsters. Exposure Children are more susceptible to coagulopathy and hypothermia due to their high surface area to volume ratio and increased metabolic demand. What is Emergency Medicine - What steps can be taken to lessen the mental strain associated with caring for damaged children?
It has been demonstrated that the employment of length, age, and weight-based dosing and equipment systems decreases anxiety among emergency care professionals, time to medicine delivery, and quantitative errors. Protocols and transfer agreements should be created beforehand. What is Emergency Medicine - What kinds of injuries do kids sustain most frequently?
90% of pediatric injuries are caused by blunt trauma, which can result in multisystem injuries due to the force being dispersed extensively throughout a child's small body. The most frequent cause of death in pediatric trauma is head injuries. The most frequent causes of severe injuries include car accidents, auto-pedestrian collisions, falls, and gunshot wounds. Nonaccidental trauma (NAT) must constantly be taken into account, unfortunately; 40% of child abuse-related deaths include infants younger than 12 months old. |
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