State 3 themes that impede triage decision making - Answers 1. Conflicting systems (pre-ED and within
ED)
2. Fluctuating patient volume
3. Personal capacity = fatigue
State the 2 main factors that appear to be related to patients leaving the ED prior to being seen by an
MD - Answers Poor communication
Uncomfortable waiting conditions
Explain how a child's small body mass alters the effect of a trauma - Answers A given force is distributed
over a small area. Causing increased number and severity of injuries and more significant internal organ
damage
Explain how the differences in a pediatric head/skull and neck alter the effects of a trauma - Answers
Large head in proportion to their body, causes high center of gravity = higher incidence of head injury
Thin and pliable cranial structures causing increased risk of serious injury
Weak neck muscles = increased injury
Explain how the differences in a pediatric thoracic cavity alter the effects of a trauma - Answers Flexible
rib cage, thinner chest wall cause greater injury due to less energy dissipation and protection
Explain how the differences in a pediatric abdominal cavity alter the effects of a trauma - Answers Thin
wall, less muscle and less subcutanous fat
Rib cage sits higher up
Abdo organs are less anchored
Greater risk of injury
Intra-abdominal trauma usually involve bleeding of large solid organs (spleen and liver)
Explain how the results of a bone injury/fracture assessment is different in a pediatric trauma - Answers
Bones are soft due to less calcification
, Takes alot of force to fracture, if the bone is fractured, be very concerned for injury to underlying or
near-by structures.
No fracture does not mean absence of injury
Explain why a child is at greater risk of hypothermia - Answers Greater surface area to mass causes
greater heat loss. Prevention is key
Explain why burns are more significant in children - Answers Thinner skin
It takes less heat to cause more serious injury
Explain how the metabolic rate varies in pediatric patients and the general approach to treatment -
Answers Higher baseline oxygen and glucose demands. Which is further increased in injury or illness
Maintain adequate oxygenation and early initiation of glucose containing fluids
Explain how blood/fluid loss is altered in pediatric patients and the general approach to treatment -
Answers Small blood volumes relatively. Small blood loss will constitute significant blood loss in children
Can adequately maintain blood pressure with increasing HR alone, but when this compensation fails,
cardiac output falls drastically
Hypotension is a late sign of fluid loss. Rapid decompensation and cardiac arrest likely
If patient does not respond to 2 weight based fluid boluses, PRBC should be initiated at 10mL/kg
Outline the pathophysiology of drowning injury - Answers Airway falls below water
Hold breath until breaking point = Hypoventilation, resp acidosis, hypoxemia
Passive airway flooding = Cardiopulmonary arrest
Rapid drop in core temp = causes sudden gasp, tachypnea, vasoconstriction, tachycardia, May also cause
arrhythmia, muscle weakness/incoordination and LOC
Outline some factors that affect the likelyhood of surviving a drowning. - Answers Length of submersion
Water quality