Page 1 of 2: TRAUMA

partha_aipg · Credits: 13148 My Scrapbook

A CHILD HAS ALLTHE FOWWOWING INJURIES SUSTAINED IN AN ACCIDENT.WHICH SHOULD BE ATTENDED FIRST?

a.extradural hematoma
b.hollow viscus injury
c.renal injury
4.pneumothorax

it was from the DNB test yesterday.cant remember if pneomothorax was in the options but probably it was.

partha

manpreet108 · Credits: 30702 My Scrapbook

i think extra dural hematoma..

draditithegreat · Credits: 1248020 My Scrapbook

if pneumothorax was one of the option then it shud be the answer!!
(i feel)

pls see:

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The primary survey or initial phase of resuscitation should address life-threatening injuries that compromise oxygenation and circulation. Make evaluation of the child's ABCs, disability, and exposure the priority of this initial phase. The Broselow Pediatric Emergency Tape is a useful guide to the management of injured children .

Airway control is the first priority. Unlike in adults, the cause of childhood cardiac arrest is an initial respiratory arrest. A child's airway is anatomically different from an adult's. A child has a shorter neck, smaller and anterior larynx, floppy epiglottis, short trachea, and large tongue. If oral intubation is indicated, use the jaw-thrust maneuver to improve airway patency. All pediatric trauma patients must be assumed to have cervical spine injury until proven otherwise. Thus, if oral intubation is indicated, in-line cervical spine immobilization must be performed.

Estimate the size of the endotracheal tube by the child's fifth digit or by the formula (age + 16)/4. The subglottic trachea is the narrowest portion of the pediatric airway and provides a “physiologic cuff,” so use uncuffed endotracheal tubes in children younger than 8 years in order to minimize tracheal trauma. Use a rapid-sequence intubation technique to facilitate successful intubation. If oral intubation is contraindicated in patients with severe maxillofacial or laryngotracheal trauma, then perform needle cricothyrotomy. Surgical cricothyroidotomy is rarely indicated in infants or small children because of the high association with secondary subglottic stenosis.

Once a patent airway is established, carefully assess the child's breathing. If respiration is inadequate, provide ventilatory assistance. Infants and small children are primarily diaphragmatic breathers; their ribs lack the rigidity and configuration present in adults. As a result, any compromise of diaphragmatic excursion significantly limits the child's ability to ventilate. Direct injury to the diaphragm, disruption and herniation of intra-abdominal contents, or gastric distension (aerophagia) can severely compromise the infant or small child's ability to breathe. The mediastinum of a child is very mobile; therefore, mediastinal structures can shift into the contralateral hemithorax as a result of a simple pneumothorax, hemothorax, or tension pneumothorax. The clinician must recognize these emergencies and intervene as needed.

Recognizing hypovolemic shock in pediatric trauma patients is essential to ensure a positive outcome. Tachycardia is usually the earliest measurable response to hypovolemia. In addition, mental status change, respiratory compromise, absence of peripheral pulses, delayed capillary refill, skin pallor, and hypothermia are all possible early signs of shock that must be immediately recognized. Children are known to have an amazing cardiovascular reserve, so the initial normal vital signs should not impart any sense of security with regard to the status of the child's circulating volume.

shraddha · Credits: 19600 My Scrapbook

pneumothorax will cause a respiratory embarrasment soon + shift will not allow intubation for draining extradural hematoma

so first pneumothorax should be taken care off

shraddha · Credits: 19600 My Scrapbook

if pneumo was not a option i would go for renal injury

becoz blood loss due to hemorrage will more in renal injury??

pratik · Credits: 11374 My Scrapbook

it was tension pneumothorax and thus it is the answer.

MockTurtle · Credits: 5617 My Scrapbook

Even if pneumo was'nt mentioned,renal trauma wouldnot have been the answer.

Excerpt:Most pediatric renal traumas are managed conservatively.The consequences of blunt renal trauma range from simple contusion or renal hematoma to complete shattering of the organ or avulsion of the vascular pedicle (1,2). In the vast majority of cases, renal injuries are minor and self-limiting (3). Conservative (expectant) treatment is increasingly accepted as the preferred approach to most renal injuries (1,4–8). In the presence of massive hemorrhage or continuous hematuria in patients with trauma-induced pseudoaneurysm or fistula, aggressive therapy may become necessary. Accepted indications for surgery are avulsion of the renal pelvis, injuries to the vascular pedicle, and life-threatening hemodynamic instability

(http://radiology.rsnajnls.org/cgi/content/full/223/3/723)
There are other sources too.Even standard texts say that.

candy · Credits: 15362 My Scrapbook

the option was tension pneumothorax partha and that should be the answer..

lazybonezzz · Credits: 54735 My Scrapbook

iagree wit candy

drshoaibsmc · Credits: 3066 My Scrapbook

Mgmt of trauma is (in the order)
A- Airway mgmt
B- Blood Pressure mgmt
C- Circulatory mgmt

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