TNCC Pediatric Trauma 3 — Questions and Answers
Question 1: An 8-year-old pedestrian struck by a vehicle presents with lower extremity fractures and an altered level of consciousness. This injury pattern is best described by which eponym?
- Chance fracture
- Waddell's triad (Correct answer)
- Le Fort fracture
- Ottawa triad
Correct answer: Waddell's triad
Waddell's triad describes the classic pediatric pedestrian injury pattern: lower extremity fracture, thoracoabdominal injury, and head injury.
Question 2: Which of the following is the most reliable indicator of adequate fluid resuscitation in a pediatric trauma patient?
- Return of normal blood pressure
- Urine output of 1 mL/kg/hr (Correct answer)
- Heart rate below 120 bpm
- Capillary refill under 3 seconds
Correct answer: Urine output of 1 mL/kg/hr
Urine output of 1 mL/kg/hr indicates adequate renal perfusion and is the most reliable ongoing indicator of resuscitation adequacy in pediatric patients.
Question 3: A 4-year-old with suspected non-accidental trauma has a spiral fracture of the humerus. What additional finding would most increase suspicion for child abuse?
- Fever and leukocytosis
- Injuries in various stages of healing (Correct answer)
- Single isolated fracture site
- Immediate parental concern at bedside
Correct answer: Injuries in various stages of healing
Multiple injuries in various stages of healing on a child is a hallmark indicator of repeated inflicted trauma and strongly suggests non-accidental injury.
Question 4: In pediatric trauma, which location is preferred for intraosseous (IO) access when IV access cannot be rapidly established?
- Distal femur
- Proximal tibia (Correct answer)
- Calcaneus
- Iliac crest
Correct answer: Proximal tibia
The proximal tibia is the preferred primary IO site in children due to the large, flat, easily palpable surface and thin cortex.
Question 5: A 10-year-old with significant thoracic trauma develops absent breath sounds on the left and tracheal deviation to the right. The immediate priority intervention is:
- Chest X-ray confirmation
- Needle decompression of the left chest (Correct answer)
- Pericardiocentesis
- Endotracheal intubation
Correct answer: Needle decompression of the left chest
Tension pneumothorax is a clinical diagnosis requiring immediate needle decompression; delaying for imaging risks rapid cardiovascular collapse.
Question 6: Which Glasgow Coma Scale (GCS) modification is used when assessing verbal response in pre-verbal infants in pediatric trauma?
- Standard adult GCS verbal score is used unchanged
- Verbal response is replaced by grimace response
- A pediatric GCS replaces coos/babble with age-appropriate speech (Correct answer)
- Verbal component is omitted and total scored out of 10
Correct answer: A pediatric GCS replaces coos/babble with age-appropriate speech
A modified pediatric GCS replaces verbal responses with age-appropriate criteria such as cooing, babbling, and crying to account for developmental language ability.
Question 7: A 6-year-old is intubated after head trauma with a GCS of 7. Which endotracheal tube size is most appropriate using the standard age-based formula?
- 4.0 mm uncuffed
- 4.5 mm uncuffed
- 5.0 mm cuffed (Correct answer)
- 5.5 mm uncuffed
Correct answer: 5.0 mm cuffed
For a 6-year-old, the formula (age/4) + 4 = 5.5, but current PALS guidelines recommend cuffed tubes; (age/4) + 3.5 = 5.0 mm cuffed is appropriate.
TNCC Pediatric Trauma 3
An 8-year-old pedestrian struck by a vehicle presents with lower extremity fractures and an altered level of consciousness.
This injury pattern is best described by which eponym?