Transcript Chapter10_11_Trauma_elderly_pediatric_women

Chapter 10 and 11
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Identify unique characteristics of the
pediatric, elderly and female patient
Identify unique injury patterns
Discuss applications of ATLS management
principles to the unique population
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Anatomic considerations
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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
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Management priorities are still the same!
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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
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Physiologic changes
Pre-existing diseases
Medications
Increasing age and decreasing organ function
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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
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Exposure: increased sensitivity to
hypothermia
MSK: most frequent cause of morbidity,
osteoporosis, fractures, preexisting
deformities, immobility may lead to
complications
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Is she pregnant?
◦ Ask, uterine enlargement, pregnancy test
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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
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Pregnancy risks:
◦ Pelvic fractures
◦ Abruptio placenta
◦ Amniotic fluid embolism
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A – Aspiration risk
B – Hyperventilation
C – Hypervolemia with anemia
D - Eclampsia
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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
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Resuscitate the mother
Monitor fetal heart tones
Consider fetal injury with
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Vaginal bleeding
Abruptio placenta
Uterine tenderness
Uterine rupture
labor
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Is she pregnant?
What are the changes?
How do these changes affect injury patterns?
How do you manage both patients?