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Pediatric Head Trauma. Antonio Sánchez González EMT-I. Pediatric trauma. Forces hit a little surface and the delivery energy cause organic damage instead localized damage .
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Pediatric Head Trauma AntonioSánchezGonzález EMT-I PreHospitalSetting.com
Pediatric trauma • Forces hit a little surface and the delivery energy cause organic damage instead localized damage. • Althoughtrauma could appear insignificant it can produce prolonged incapacity, either cerebral, organic or psychological PreHospitalSetting.com
Pd Head trauma • Compound fractures , depressed or penetrating injuries generally implies cerebral tissue damage and are consider critical. • Lineal fractures may or not related with cerebral damage. PreHospitalSetting.com
Skull fracture signals: • Periorbital Echimosis (raccoon eyes) • Retroauricular Echimosis (battle’s sign) • Hemotímpano • CSF Drainage PreHospitalSetting.com
Pd Head trauma • Laceration: Implies damage to the cerebral tissue, morbidity depends on extension of injury and secondary vascular complications PreHospitalSetting.com
Pd Head trauma Epidural hemorrhage • It is localized between skull and the dura • Result of damage in middle meningeal artery • It is Associated to lineal Fx, depressed or temporal fracture PreHospitalSetting.com
Pd Head trauma • Posterior Hemorrhage: Shows nape rigidity, cerebelosus signs, vomiting and progressive lost of consciousness PreHospitalSetting.com
Pd Head trauma • Subdural hemorrhage: Affects mainly to young children Symptoms is slow, without specific clinical data but we can find vomit, irritability and hypertermia. Symptoms may be present in subacute or chronic phases as generalized or focal seizures PreHospitalSetting.com
Pd Head trauma • Cerebral functions and reflexes are present, but cortical functions as memory and fine motor coordination are not completely developed and sometimes can not be assessed. • Cortical injury can be not detected before 6 months PreHospitalSetting.com
Pd Head trauma • Infant’s brain have a great amount of water and is not completely evolved by myelin, thus is more susceptible for diffuse injury. • Symptoms are lose of conscious and midriasis PreHospitalSetting.com
Pd Head trauma • Increase on ICP by edema must be assessed early: • Children with GCS 5 or motor parameter 2 • Politrauma • Hypovolemia • Prolonged assessment and stabilization PreHospitalSetting.com
Increase on Intracraneal Pressure • Primary symptoms. • Headache, nausea, vomit y altered mental status. • Late symptoms • Increase on systolic blood pressure • Altered breathing • Decrease of pulse PreHospitalSetting.com
Increase on Intracraneal Pressure • Very late symptoms • Ataxic breathing • Midriatic pupils and without response to light • Disritmia PreHospitalSetting.com
Craneal nerve injury • I Cranial nerve: • decrease of sense of smell or taste • II cranial nerve: • Blindness or altered vision • III cranial nerve: • Fixed and dilated pupils • VII cranial nerve: • Facial Paralysis • VIII cranial nerve: • Deafness PreHospitalSetting.com
Spinal trauma Pd • Spinal ligaments and articular capsules are more flexible • Children have a prominent occiput, thereby cause neck flexion when the child lay supine and it can occlude the unprotected airway • Children below 7 years old present anterior displacement ofC2 y C3 PreHospitalSetting.com
Spinal Trauma Pd • In some toddlers we can find a great distance between the odontoid of C2 and the anterior arc of C1 • Growing centers may appear such fractures • Cord injury may present without radiological abnormality (SCIWORA) PreHospitalSetting.com
Pediatric Trauma Inappropriate care in the immediate posttraumatic period may affect survive and posterior life quality PreHospitalSetting.com
Assessment • Airway • Obstruction: secretions, strange objects, bleeding, edema, hematoma... • Control cervical spine while perform any airway maneuver and inmovilization PreHospitalSetting.com
Assessment • Breathing • Apnea o Bradypnea • Diminished on breathing sounds • if pneumotorax are present may not be heard the leak on ventilation. PreHospitalSetting.com
Assessment • Circulation • Weak cardiac sounds • Diminished capillary refill • Tachycardia, hypertension, Bradycardia • Hemorrhage • Discrepancy between central and distal pulses • Jugular vein distension PreHospitalSetting.com
Sistemic response to blood lose PreHospitalSetting.com
Treatment • Airway • Chin lift, jaw trust • Oropharingeal airway, ETI, PTV • CONTROL OF CERVICAL SPINE PreHospitalSetting.com
Treatment • CERVICAL SPINE CONTROL PreHospitalSetting.com
RSI • Children with head trauma are in risk to develop increase on intracraneal pressure and sometimes they have significant pain • Rapid sequence intubation can diminished the increase on BP and ICP specially with use of tiophental y Lidocaine. PreHospitalSetting.com
Drugs • Manitol and furosemide can decrease the intracraneal pressure, but their use can be restricted to hospital • The best actions in prehospital setting are to keep a good perfusion and oxygenation PreHospitalSetting.com
Treatment • Breathing • 100% Oxygen • Treatment of apnea • Positive pressure ventilation • Aspiration of pneumotorax • Tidal volume calculated at (10 - 15 cc)(kg) PreHospitalSetting.com
Treatment • Circulation • Two large bore peripheral catheters • Crystalloid 20 cc/kg • In massive bleeding may be request fluids at 3:1 • Control hemorrhages and avoid fall of BP • children do not show early decompeNsation PreHospitalSetting.com
Pediatrics • Weight weight (kg) = 8 + ( 2 x age in years ) • Systolic blood pressure SBP (mm Hg) = 80 + ( 2 x age in years ) • diastolic blood pressure DBP = 2/3 SBP • total blood volume Volume (cc) = 80 cc x weight in kg PreHospitalSetting.com
Treatment • Disability • AVPU SCALE • GLASGOW COMA SCALE • PEDIATRIC TRAUMA SCORE (score < 8 transport to trauma center) • PUPILS PreHospitalSetting.com
Treatment • ESCALA DE AVDI PreHospitalSetting.com
PEDIATRIC GLASGOW COMA SCALE • EYE RESPONSE • 4 Spontaneous • 3 Verbal • 2 Pain • 1 No response MOTORA RESPONSE 6 Spontaneous and purposefully 5 Withdraws to touch 4 Withdraws to pain 3 Decorticating 2 Decerebration) 1 No response VERBAL RESPONSE 5 Coos and babbles 4 Irritable cries 3 Cries to pain 2 moans, grunts 1 No response PreHospitalSetting.com
Pediatric Trauma Score PreHospitalSetting.com
Treatment • Expose • Remove clothes for search and asses injuries and bleeding • Avoid hypothermia PreHospitalSetting.com
Battered /abuse CHIld • Is the damage by inappropriate or abnormal care, include physical, sexual or emotional abuse, negligence, inappropriate accidental injuries and neglect. • Is import for treat trauma and avoid future injuries or even death PreHospitalSetting.com
Battered /abuse CHIld • Children below 6 years old rarely present injuries by them self • 90% of them present superficial injuries and others shows injuries at different stages of healing • Assess behavior concern child and caregiver and incongruent history about injuries PreHospitalSetting.com
Quick guide for pediatric head trauma • Kinematics • Altered mental status • Suspect or evidences of Fractures or penetrating injuries in head. • Continuous Seizures PreHospitalSetting.com
Quick guide for pediatric head trauma • Signs of increase in intracraneal pressure • Persistent emesis • Amnesia • Abnormal Neurological exam (AVPU or Glasgow) PreHospitalSetting.com
Trauma pediátrico IS INDISPENSABLE THAT INJURIED CHILD RECEIVE EXPERT MANEGEMENT ON SCENE, ON TRANSPORT AND IN HOSPITAL PreHospitalSetting.com
THANKS AntonioSánchezGonzález EMT-I PreHospitalSetting.com