ATLS- PEDIATRIC TRAUMA QUESTIONS WITH
CORRECT ANSWERS 2026-2027
StatsJ- correct answer-- injury is the most commonJcause of mortality/morbidity in childhood
- MVA-
associatedJinjuries are the mostJcommon cause of death inJchildren of all ages (followed by drowning, house
fires, homicides andJfalls)
- Child physical abuse accounts for majority of homicides in infants
- FirearmJinjuriesJaccount for majority of homicides inJchildren/adolescents
- Falls account for majority of all pediatric injuries but infrequently cause death
- most serious pediatric trauma is blunt trauma involving the brain
-
60% of children who sustain severe multisystem trauma have residual personality changes at 1 yr after hospi
tla dis charge and 50% show cognitive/physical handicaps
- 50% of seriously injured children show social/affective/learning disabilities
- 2/3 of siblings of children with injuries show personality and emotional disturbances
What aspects of childhood anatomy need to be considered? - correct answer-1. smaller body mass--
> energy imparted from bumpers/falls results in a GREATERJforce applied per unitJof body area (more inten
se energy is transmitted to a body that has less fat/connective tissue and close proximity of multiple organs --
> high frequency of multiple injuries
2. head proportionately larger --> higher frequency of blunt brain injuries
3. skeleton is incompletely calcified, contains multipleJactive growth centres and is moreJpliable---
> internal organ damage often occurs without overlying bony fracture eg rib# are uncommon but pulmonary
contusion is not. Skull or ribJfractures suggests MASSIVE transfer of energy
4. surface area: body volume decreases asJchild matures --> hypothermia may develop quickly
5. psychological status--> emotional instability -->Jregressive behaviour
6. long-term effects- effect on subsequent growth and development and psychological impact
How do I apply ATLS principles toJthe treatmentJof children? - correctJanswer-AIRWAY + c-spine-
establish/maintain patency and adequate oxygenation.
> if spontaneous breathing and partial obstruction use jaw-thrust + bimanual in-lineJimmobilisation
> if unconscious, mechanical methods are needed
> ALWAYS preoxygenate fully before attempting mechanical airway
1) oral airway- useJtongue depressor and gently insert directly into oropharynx
, 2) orotracheal intubation
- use uncuffed tube initially (esp if <9yo) to avoidJsubglottic edema, ulceration and disruption of airway
BREATHING
CIRCULATION AND SHOCK
-
earliest signs of hypovolemia are tachycardia and poor skin perfusion. Also narrowing of pulse pressure, we
akening of peripheral pulses, skin mottling, cool extremities, decreased LOC in response to pain.
- Later changes- decrease in BP andJUO
- nil BP changes until 30% blood loss
-
hypotension in a child represents aJstate of DECOMPENSATED SHOCKJand indicates severe blood loss >
45% blood volume
-
when shockJsuspected give IVF bolus 20mL/kg, after 3 xJboluses, it may be necessary to administer pRBC b
olusJof 10mL/kg
-
venous access: 2 x attempts at IVC, then intraosseous infusion viaJBM needle (18G infants, 15GJyoung child
ren)
- UOJ1-
2mL/kg and urine specificJgravity is a good method of determining adequacy of volume resuscitation, straig
ht catheter rather than a balloon catheter can be used
- thermoregulation
AIRWAY ANATOMY - correct answer--
theJsmaller the child, the greater the disproportion between size of cranium and midfaceJ--
> propensity forJposteriorJpharynx to buckle anteriorly due to passive flexion fo the c-
spineJ(caused by largeJocciput)
- soft tissues in infants' oropharynx ieJtonsils and tongue are relatively largeJcf oral cavity --
> difficult to visualiseJthe larynx
- child's larynx is funnel-shapedJ--
> secretions accumulate in the retropharyngeal area. ItJis alsoJmore cephalad and anterior in the neck
- vocal cords have a moreJanterocaudal angle
- infantJtrachea is 5cm long (ie short), growsJby 7cm by about 18 months
- smallest area of theJyoung childs airway is the cricoid ring
CORRECT ANSWERS 2026-2027
StatsJ- correct answer-- injury is the most commonJcause of mortality/morbidity in childhood
- MVA-
associatedJinjuries are the mostJcommon cause of death inJchildren of all ages (followed by drowning, house
fires, homicides andJfalls)
- Child physical abuse accounts for majority of homicides in infants
- FirearmJinjuriesJaccount for majority of homicides inJchildren/adolescents
- Falls account for majority of all pediatric injuries but infrequently cause death
- most serious pediatric trauma is blunt trauma involving the brain
-
60% of children who sustain severe multisystem trauma have residual personality changes at 1 yr after hospi
tla dis charge and 50% show cognitive/physical handicaps
- 50% of seriously injured children show social/affective/learning disabilities
- 2/3 of siblings of children with injuries show personality and emotional disturbances
What aspects of childhood anatomy need to be considered? - correct answer-1. smaller body mass--
> energy imparted from bumpers/falls results in a GREATERJforce applied per unitJof body area (more inten
se energy is transmitted to a body that has less fat/connective tissue and close proximity of multiple organs --
> high frequency of multiple injuries
2. head proportionately larger --> higher frequency of blunt brain injuries
3. skeleton is incompletely calcified, contains multipleJactive growth centres and is moreJpliable---
> internal organ damage often occurs without overlying bony fracture eg rib# are uncommon but pulmonary
contusion is not. Skull or ribJfractures suggests MASSIVE transfer of energy
4. surface area: body volume decreases asJchild matures --> hypothermia may develop quickly
5. psychological status--> emotional instability -->Jregressive behaviour
6. long-term effects- effect on subsequent growth and development and psychological impact
How do I apply ATLS principles toJthe treatmentJof children? - correctJanswer-AIRWAY + c-spine-
establish/maintain patency and adequate oxygenation.
> if spontaneous breathing and partial obstruction use jaw-thrust + bimanual in-lineJimmobilisation
> if unconscious, mechanical methods are needed
> ALWAYS preoxygenate fully before attempting mechanical airway
1) oral airway- useJtongue depressor and gently insert directly into oropharynx
, 2) orotracheal intubation
- use uncuffed tube initially (esp if <9yo) to avoidJsubglottic edema, ulceration and disruption of airway
BREATHING
CIRCULATION AND SHOCK
-
earliest signs of hypovolemia are tachycardia and poor skin perfusion. Also narrowing of pulse pressure, we
akening of peripheral pulses, skin mottling, cool extremities, decreased LOC in response to pain.
- Later changes- decrease in BP andJUO
- nil BP changes until 30% blood loss
-
hypotension in a child represents aJstate of DECOMPENSATED SHOCKJand indicates severe blood loss >
45% blood volume
-
when shockJsuspected give IVF bolus 20mL/kg, after 3 xJboluses, it may be necessary to administer pRBC b
olusJof 10mL/kg
-
venous access: 2 x attempts at IVC, then intraosseous infusion viaJBM needle (18G infants, 15GJyoung child
ren)
- UOJ1-
2mL/kg and urine specificJgravity is a good method of determining adequacy of volume resuscitation, straig
ht catheter rather than a balloon catheter can be used
- thermoregulation
AIRWAY ANATOMY - correct answer--
theJsmaller the child, the greater the disproportion between size of cranium and midfaceJ--
> propensity forJposteriorJpharynx to buckle anteriorly due to passive flexion fo the c-
spineJ(caused by largeJocciput)
- soft tissues in infants' oropharynx ieJtonsils and tongue are relatively largeJcf oral cavity --
> difficult to visualiseJthe larynx
- child's larynx is funnel-shapedJ--
> secretions accumulate in the retropharyngeal area. ItJis alsoJmore cephalad and anterior in the neck
- vocal cords have a moreJanterocaudal angle
- infantJtrachea is 5cm long (ie short), growsJby 7cm by about 18 months
- smallest area of theJyoung childs airway is the cricoid ring
