LTC 2014 Session 1

Summary of morning session at the 2014 London Trauma Conference. The full programme of the meeting can be found here.

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.

 

 

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s