Chapter 10 and 11
Jan 12, 2016
Chapter 10 and 11
Identify unique characteristics of the pediatric, elderly and female patient
Identify unique injury patterns Discuss applications of ATLS management
principles to the unique population
Anatomic considerations◦ Narrow upper airway◦ Anterior, funnel-shaped larynx◦ Short trachea◦ Pliable soft chest wall◦ Softer thinner-walled abdomen◦ Lower-riding liver◦ Flexible spine◦ Thin skin and high ratio BSA:body mass
Sign 0 to 3 years 3 to 5 years 6 to 12 years
HR <150 – 160 <140 <100 – 120
BP >60 – 70 >75 >80 – 90
RR <40 – 60 <35 <30
Urinary output 2 mL/kg 1 mL/kg 0.5 mL/kg
Management priorities are still the same! A - Size of uncuffed ET tube B - Compliant ribs, chest tube size C - Fluid challenge, use of blood D - GCS score, pediatric verbal score E - Prevent heat loss
Physiologic changes Pre-existing diseases Medications Increasing age and decreasing organ
function
Difficult intubation: cervical arthritis, mucosal fragility
Unique breathing problems: diminished reserve, COPD, chest injuries poorly tolerated
Unique circulatory problems: fixed HR, hypertension, limited reserve, renal function, medications
Unique neuro problems: subdural hematomas, altered sensorium, spinal osteoarthritis
Exposure: increased sensitivity to hypothermia
MSK: most frequent cause of morbidity, osteoporosis, fractures, preexisting deformities, immobility may lead to complications
Is she pregnant?◦ Ask, uterine enlargement, pregnancy test
Pregnancy changes:◦ Uterus intrapelvic and thick-walled in 1st trimester◦ Uterus extrapelvic and large volume fluid in 2nd ◦ Uterus thin-walled and displaced organs in 3rd
Pregnancy risks:◦ Pelvic fractures◦ Abruptio placenta◦ Amniotic fluid embolism
A – Aspiration risk B – Hyperventilation C – Hypervolemia with anemia D - Eclampsia
A – same as non-pregnant B – Same as non-pregnant C – displace uterus/volume infusion D – Eclampsia vs brain injury E – same as non-pregnant
Resuscitate the mother Monitor fetal heart tones Consider fetal injury with
◦ Vaginal bleeding◦ Abruptio placenta◦ Uterine tenderness◦ Uterine rupture◦ labor
Is she pregnant? What are the changes? How do these changes affect injury
patterns? How do you manage both patients?