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Pediatric Head Trauma

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

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  1. Pediatric Head Trauma AntonioSánchezGonzález EMT-I PreHospitalSetting.com

  2. 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

  3. 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

  4. Skull fracture signals: • Periorbital Echimosis (raccoon eyes) • Retroauricular Echimosis (battle’s sign) • Hemotímpano • CSF Drainage PreHospitalSetting.com

  5. Pd Head trauma • Laceration: Implies damage to the cerebral tissue, morbidity depends on extension of injury and secondary vascular complications PreHospitalSetting.com

  6. 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

  7. Pd Head trauma • Posterior Hemorrhage: Shows nape rigidity, cerebelosus signs, vomiting and progressive lost of consciousness PreHospitalSetting.com

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. Increase on Intracraneal Pressure • Very late symptoms • Ataxic breathing • Midriatic pupils and without response to light • Disritmia PreHospitalSetting.com

  14. 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

  15. 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

  16. 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

  17. Pediatric Trauma Inappropriate care in the immediate posttraumatic period may affect survive and posterior life quality PreHospitalSetting.com

  18. Assessment • Airway • Obstruction: secretions, strange objects, bleeding, edema, hematoma... • Control cervical spine while perform any airway maneuver and inmovilization PreHospitalSetting.com

  19. Assessment • Breathing • Apnea o Bradypnea • Diminished on breathing sounds • if pneumotorax are present may not be heard the leak on ventilation. PreHospitalSetting.com

  20. Assessment • Circulation • Weak cardiac sounds • Diminished capillary refill • Tachycardia, hypertension, Bradycardia • Hemorrhage • Discrepancy between central and distal pulses • Jugular vein distension PreHospitalSetting.com

  21. Sistemic response to blood lose PreHospitalSetting.com

  22. Treatment • Airway • Chin lift, jaw trust • Oropharingeal airway, ETI, PTV • CONTROL OF CERVICAL SPINE PreHospitalSetting.com

  23. Treatment • CERVICAL SPINE CONTROL PreHospitalSetting.com

  24. 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

  25. 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

  26. Treatment • Breathing • 100% Oxygen • Treatment of apnea • Positive pressure ventilation • Aspiration of pneumotorax • Tidal volume calculated at (10 - 15 cc)(kg) PreHospitalSetting.com

  27. 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

  28. 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

  29. Treatment • Disability • AVPU SCALE • GLASGOW COMA SCALE • PEDIATRIC TRAUMA SCORE (score < 8 transport to trauma center) • PUPILS PreHospitalSetting.com

  30. Treatment • ESCALA DE AVDI PreHospitalSetting.com

  31. 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

  32. Pediatric Trauma Score PreHospitalSetting.com

  33. Treatment • Expose • Remove clothes for search and asses injuries and bleeding • Avoid hypothermia PreHospitalSetting.com

  34. 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

  35. 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

  36. Quick guide for pediatric head trauma • Kinematics • Altered mental status • Suspect or evidences of Fractures or penetrating injuries in head. • Continuous Seizures PreHospitalSetting.com

  37. Quick guide for pediatric head trauma • Signs of increase in intracraneal pressure • Persistent emesis • Amnesia • Abnormal Neurological exam (AVPU or Glasgow) PreHospitalSetting.com

  38. Trauma pediátrico IS INDISPENSABLE THAT INJURIED CHILD RECEIVE EXPERT MANEGEMENT ON SCENE, ON TRANSPORT AND IN HOSPITAL PreHospitalSetting.com

  39. THANKS AntonioSánchezGonzález EMT-I PreHospitalSetting.com

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