Paediatric Trauma – Mr. Ross Fisher, Sheffield Children’s Hospital
“CHILDREN ARE NOT SMALL ADULTS”
- A rare event. 37 paediatric polytraumas per annum per unit; most present to trauma units not MTCs.
- 37% mortality.
- Over triage a problem. PECARN prediction tool for abdominal trauma may be useful [http://www.ncbi.nlm.nih.gov/pubmed/23375510]
- Whole-body CT equivalent 1000 CXRs in child. Utilise ALARA (as low as reasonably achievable) principle.
- FAST scan in paediatric trauma 50% sensitivity (use coin toss instead!)
- Primary prevention still most important way to reduce paediatric trauma deaths.
- As with adults, rehabilitation is vital to outcomes; again must be paediatric specific.
Trauma in pregnancy – Professor Tim Draycott, University of Bristol.
“WHAT IS BEST FOR MOTHER IS BEST FOR THE BABY”
- <1% trauma admissions are pregnant.
- If patient needs trauma surgery, stay in MTC; if patient needs obstetric surgery go to Obs.
- If 2nd/3rd trimester and >50% burns, deliver baby for maternal benefit.
- If needs ICD put in 1-2 spaces higher to avoid fetus.
- After 4 minutes of unsuccessful CPR, perimortem LSCS (for maternal benefit) [4 in UK in most recent CEMACH report].
- In USA obstetric trauma (RTC 55%, Domestic violence 22%, Falls 22%).
- CEMACE report 2014 – 11x more obstetric deaths with influenza than RTCs.
- Head injury remains the most common injury in pregnant patients.
- Gun-shot wounds: if below fundus almost never visceral injury; fetal death rate 67%.
- Stabbing: 93% morbidity, 50% mortality. If involves uterus then need exploratory laparotomy.
- Most eclampic fits only last 90s. DO NOT GIVE DIAZEPAM.
- TXA safe in pregnancy.
- Cord prolapse; don’t touch the cord, keep the cord warm, fill the bladder with 500 ml fluid (stops fetal head compressing cord), transfer.
- Breech delivery; don’t interfere. Let the mother push.
- If pre-term birth, put the baby in a plastic freezer bag to keep it warm.
- Cardiac arrest –manual displacement of uterus [aortocaval compression decrease efficacy of CPR] but otherwise standard ALS.