Pediatric Trauma Considerations Flashcards

A 6-year-old pedestrian struck by a car typically sustains a predictable pattern of injuries known as Waddell's triad. What injuries comprise this pattern?

Answer: Femur or tibia fracture (bumper height), trunk injury (hood/fender), and head injury (ground impact)

Waddell's triad describes the classic pediatric pedestrian injury pattern: lower extremity fracture from bumper impact, thoracic/abdominal injury from being thrown onto the hood, and head injury from subsequent ground impact.

How does the Broselow tape assist ITLS providers in pediatric trauma resuscitation?

Answer: It provides a length-based estimate of weight and corresponding equipment sizes, drug doses, and fluid volumes coded by color zones

The Broselow tape uses the child's length to estimate weight, then provides color-coded zones that correspond to pre-calculated drug doses, fluid volumes, and appropriately sized equipment (ETT, blade, etc.).

A 2-year-old has symmetric bilateral rib fractures in various stages of healing along with retinal hemorrhages. What should the ITLS provider consider?

Answer: Non-accidental trauma (child abuse) should be strongly suspected based on the injury pattern inconsistent with a single accidental event

Bilateral rib fractures in various stages of healing indicate repetitive trauma over time, and retinal hemorrhages are strongly associated with abusive head trauma. This injury pattern is inconsistent with any single accidental mechanism.

When positioning a pediatric patient on a backboard for spinal immobilization, why is padding needed under the torso rather than under the head?

Answer: The child's proportionally larger occiput forces the cervical spine into flexion on a flat surface; padding the torso brings the spine to neutral alignment

Children's disproportionately large occiput (back of the head) causes cervical flexion when placed on a flat backboard. Placing padding (1-2 inches) under the torso elevates it to match the occiput's height, achieving neutral cervical alignment.

A 10-year-old falls from a tree (15 feet) and is complaining of abdominal pain. Vitals show HR 140, BP 90/60, RR 28. What does the tachycardia and borderline blood pressure indicate in this pediatric patient?

Answer: Significant hemorrhage with decompensating shock—children maintain blood pressure until they have lost 30-40% of blood volume, so hypotension indicates a critical state

In children, blood pressure is maintained until very late in shock (30-40% volume loss). A BP of 90/60 with tachycardia in a 10-year-old with abdominal pain after a significant fall indicates decompensating hemorrhagic shock requiring immediate aggressive intervention.

What is the appropriate size endotracheal tube for a 6-year-old child, and how is it calculated?

Answer: Use the formula (age/4) + 4 for uncuffed tubes, giving a 5.5 mm tube; or (age/4) + 3.5 for cuffed tubes, giving a 5.0 mm cuffed tube

ETT size is calculated using (age/4) + 4 for uncuffed tubes or (age/4) + 3.5 for cuffed tubes. For a 6-year-old: (6/4) + 4 = 5.5 mm uncuffed, or (6/4) + 3.5 = 5.0 mm cuffed.