Pediatric Trauma

 

Pediatric Trauma (Not Just Small Adults)

S󰁕RG GP. 425

Monday, Oct 29 2007

󰁄󰁲. 󰁁󰁡󰁹󰁥󰁤 󰁁󰁬󰀭󰁑 󰁡󰁨󰁴󰁡󰁮󰁩 󰁡󰁨󰁴󰁡󰁮󰁩  

󰁁󰁳󰁳. 󰁐󰁲󰁯󰁦󰁥󰁳󰁳󰁯󰁲 & 󰁃󰁯󰁮󰁳󰁵󰁬󰁴󰁡󰁮󰁴 󰁰󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣 󰁳󰁵󰁲󰁧󰁥󰁲󰁹

Outline utline :  : ♣  B󰁡󰁣󰁫󰁧󰁲󰁯󰁵󰁮󰁤 . ♣  T󰁲󰁡󰁵󰁭󰁡 󰁳󰁣󰁯󰁲󰁥󰁳 . ♣  P󰁲󰁩󰁮󰁣󰁩󰁰󰁬󰁥󰁳 󰁡󰁮󰁤 A󰁰󰁰󰁲󰁯󰁡󰁣󰁨 . ♣  ABC󲀙󰁳 . ♣  S󰁰󰁥󰁣󰁩󰁦󰁩󰁣 󰁩󰁮󰁪󰁵󰁲󰁩󰁥󰁳  H󰁥󰁡󰁤,

C󰀭S󰁰󰁩󰁮󰁥, C󰁨󰁥󰁳󰁴, A󰁢󰁤󰁯󰁭󰁩󰁮󰁡󰁬, B󰁵󰁲󰁮󰁳

♣  A󰁢󰁵󰁳󰁥 .

Background ackground:: ♣  L󰁥󰁡󰁤󰁩󰁮󰁧 󰁣󰁡󰁵󰁳󰁥 󰁯󰁦 󰁤󰁥󰁡󰁴󰁨 󰁩󰁮 󰁰󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣 󰁡󰁧󰁥. ♣  < 5 󰁹󰁥󰁡󰁲󰁳 󰁨󰁩󰁧󰁨󰁥󰁳󰁴 󰁲󰁩󰁳󰁫. ♣  B󰁯󰁹󰁳 > 󰁧󰁩󰁲󰁬󰁳. ♣  B󰁬󰁵󰁮󰁴 > 󰁰󰁥󰁮󰁥󰁴󰁲󰁡󰁴󰁩󰁮󰁧   F󰁡󰁬󰁬󰁳>M󰁖A (M󰁯󰁴󰁯󰁲 󰁖󰁥󰁨󰁩󰁣󰁬󰁥 A󰁣󰁣󰁩󰁤󰁥󰁮󰁴) >MPA>󰁲󰁥󰁣>󰁡󰁢󰁵󰁳󰁥>󰁤󰁲󰁯 >MPA>󰁲󰁥󰁣>󰁡󰁢󰁵󰁳󰁥>󰁤󰁲󰁯󰁷󰁮>󰁢󰁵󰁲󰁮󰁳. 󰁷󰁮>󰁢󰁵󰁲󰁮󰁳. ♣  R󰁥󰁧󰁩󰁯󰁮󰁡󰁬󰁩󰁺󰁥󰁤 󰁰󰁥󰁤󰁳 󰁴󰁲󰁡󰁵󰁭󰁡 󰁣󰁥󰁮󰁴󰁥󰁲󰁳.   I󰁭󰁰󰁲󰁯󰁶󰁥󰁤 󰁭󰁯󰁲󰁴󰁡󰁬󰁩󰁴󰁹 󰁯󰁦 󰁳󰁥󰁶󰁥󰁲󰁥󰁬󰁹 󰁩󰁮󰁪󰁵󰁲󰁥󰁤 󰁣󰁨󰁩󰁬󰁤 . Basic ATLS concepts include: include: ♣  T󰁲󰁥󰁡󰁴 󰁴󰁨󰁥 󰁧󰁲󰁥󰁡󰁴󰁥󰁳󰁴 󰁴󰁨󰁲󰁥󰁡󰁴 󰁴󰁯 󰁬󰁩󰁦󰁥 󰁦󰁩󰁲󰁳󰁴. ♣  T󰁨󰁥 󰁬󰁡󰁣󰁫 󰁯󰁦 󰁡 󰁤󰁥󰁦󰁩󰁮󰁩󰁴󰁩󰁶󰁥 󰁤󰁩󰁡󰁧󰁮󰁯󰁳󰁩󰁳 󰁳󰁨󰁯󰁵󰁬󰁤 󰁮󰁥󰁶󰁥󰁲 󰁩󰁭󰁰󰁥󰁤󰁥 󰁴󰁨󰁥 󰁡󰁰󰁰󰁬󰁩󰁣󰁡󰁴󰁩󰁯󰁮 󰁯󰁦 󰁡󰁮 󰁩󰁮󰁤󰁩󰁣󰁡󰁴󰁥󰁤 󰁴󰁲󰁥󰁡󰁴󰁭󰁥󰁮󰁴. ♣  A 󰁤󰁥󰁴󰁡󰁩󰁬󰁥󰁤 󰁨󰁩󰁳󰁴󰁯󰁲󰁹 󰁩󰁳 󰁮󰁯󰁴 󰁡󰁮 󰁥󰁳󰁳󰁥󰁮󰁴󰁩󰁡󰁬 󰁰󰁲󰁥󰁲󰁥󰁱󰁵󰁩󰁳󰁩󰁴󰁥 󰁴󰁯 󰁢󰁥󰁧󰁩󰁮 󰁥󰁶󰁡󰁬󰁵󰁡󰁴󰁩󰁮󰁧 󰁡󰁮 󰁡󰁣󰁵󰁴󰁥󰁬󰁹 󰁩󰁮󰁪󰁵󰁲󰁥󰁤 󰁰󰁡󰁴󰁩󰁥󰁮󰁴 (󰁭󰁥󰁡󰁮󰁩󰁮󰁧 󰁤󰁥󰁴󰁡󰁩󰁬󰁥󰁤 󰁨󰁩󰁳󰁴󰁯󰁲󰁹 󰁩󰁳 󰁮󰁯󰁴 󰁩󰁮󰁩󰁴󰁩󰁡󰁬󰁬󰁹 󰁲󰁥󰁱󰁵󰁩󰁲󰁥󰁤).

󰁥   1󰁼󰁐󰁡󰁧󰁥

 

Pediatric Trauma (Not Just Small Adults)

S󰁕RG GP. 425

Monday, Oct 29 2007

󰁄󰁲. 󰁁󰁡󰁹󰁥󰁤 󰁁󰁬󰀭󰁑 󰁡󰁨󰁴󰁡󰁮󰁩 󰁡󰁨󰁴󰁡󰁮󰁩  

󰁁󰁳󰁳. 󰁐󰁲󰁯󰁦󰁥󰁳󰁳󰁯󰁲 & 󰁃󰁯󰁮󰁳󰁵󰁬󰁴󰁡󰁮󰁴 󰁰󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣 󰁳󰁵󰁲󰁧󰁥󰁲󰁹

Principles rinciples:: I󰁭󰁰󰁲󰁯󰁰󰁥󰁲 󰁲󰁥󰁳󰁵󰁳󰁣󰁩󰁴󰁡󰁴󰁩󰁯󰁮 󰁨󰁡󰁳 󰁢󰁥󰁥󰁮 󰁩󰁤󰁥󰁮󰁴󰁩󰁦󰁩󰁥󰁤 󰁡󰁳 󰁡 󰁭󰁡󰁪󰁯󰁲 󰁣󰁡󰁵󰁳󰁥 󰁯󰁦 󰁰󰁲󰁥󰁶󰁥󰁮󰁴󰁡󰁢󰁬󰁥 󰁰󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣 󰁤󰁥󰁡󰁴󰁨. C󰁯󰁭󰁭󰁯󰁮 󰁥󰁲󰁲󰁯󰁲󰁳 󰁩󰁮 󰁲󰁥󰁳󰁵󰁳󰁣󰁩󰁴󰁡󰁴󰁩󰁯󰁮 󰁩󰁮󰁣󰁬󰁵󰁤󰁥 󰁦󰁡󰁩󰁬󰁵󰁲󰁥 󰁴󰁯:

♣  O󰁰󰁥󰁮 󰁡󰁮󰁤 󰁭󰁡󰁩󰁮󰁴󰁡󰁩󰁮 󰁴󰁨󰁥 󰁡󰁩󰁲󰁷󰁡󰁹. 󰁩󰁮󰁪 󰁵󰁲󰁥󰁤 󰁣󰁨󰁩󰁬󰁤󰁲󰁥󰁮. ♣  P󰁲󰁯󰁶󰁩󰁤󰁥 󰁡󰁰󰁰󰁲󰁯󰁰󰁲󰁩󰁡󰁴󰁥 󰁡󰁮󰁤 󰁡󰁤󰁥󰁱󰁵󰁡󰁴󰁥 󰁦󰁬󰁵󰁩󰁤 󰁲󰁥󰁳󰁵󰁳󰁣󰁩󰁴󰁡󰁴󰁩󰁯󰁮 󰁴󰁯 󰁨󰁥󰁡󰁤 󰁩󰁮󰁪󰁵󰁲󰁥󰁤

♣  R󰁥󰁣󰁯󰁧󰁮󰁩󰁺󰁥 󰁡󰁮󰁤 󰁴󰁲󰁥󰁡󰁴 󰁩󰁮󰁴󰁥󰁲󰁮󰁡󰁬 󰁨󰁥󰁭󰁯󰁲󰁲󰁨󰁡󰁧󰁥.

Trimodal distribution of death from injuries: injuries:   ♣  T󰁨󰁥 󰁦󰁩󰁲󰁳󰁴 󰁰󰁥󰁡󰁫 󰁯󰁦 󰁤󰁥󰁡󰁴󰁨 󰁩󰁳 󰁷󰁩󰁴󰁨󰁩󰁮 󰁭󰁩󰁮󰁵󰁴󰁥󰁳 󰁯󰁦 󰁴󰁨󰁥 󰁩󰁮󰁪󰁵󰁲󰁹 󰁵󰁳󰁵󰁡󰁬󰁬󰁹 󰁤󰁵󰁥 󰁴󰁯:   B󰁲󰁡󰁩󰁮 , 󰁢󰁲󰁡󰁩󰁮 󰁳󰁴󰁥󰁭, 󰁨󰁩󰁧󰁨 󰁳󰁰󰁩󰁮󰁡󰁬 󰁳 󰁰󰁩󰁮󰁡󰁬 󰁣󰁯󰁲󰁤, 󰁨󰁥󰁡󰁲󰁴, 󰁧󰁲󰁥󰁡󰁴 󰁶󰁥󰁳󰁳󰁥󰁬󰁳. 󰁩󰁮󰁪 󰁵󰁲󰁹 ♣  T󰁨󰁥 󰁳󰁥󰁣󰁯󰁮󰁤 󰁰󰁥󰁡󰁫 󰁯󰁣󰁣󰁵󰁲󰁳 󰁷󰁩󰁴󰁨󰁩󰁮 󰁭󰁩󰁮󰁵󰁴󰁥󰁳 󰁴󰁯 󰁳󰁥󰁶󰁥󰁲󰁡󰁬 󰁨󰁯󰁵󰁲󰁳 󰁯󰁦 󰁴󰁨󰁥 󰁩󰁮󰁪󰁵󰁲󰁹   T󰁨󰁩󰁳 󰁩󰁳 󰁴󰁨󰁥 󰁰󰁥󰁲󰁩󰁯󰁤 󰁴󰁨󰁡󰁴 ATLS (A󰁤󰁶󰁡󰁮󰁣󰁥󰁤 T󰁲󰁡󰁵󰁭󰁡 L󰁩󰁦󰁥 S󰁵󰁰󰁰󰁯󰁲󰁴) 󰁦󰁯󰁣󰁵󰁳󰁥󰁳 󰁵󰁰󰁯󰁮 (*󰁴󰁨󰁥 󰁭󰁯󰁳󰁴 󰁩󰁭󰁰󰁯󰁲󰁴󰁡󰁮󰁴). ♣  T󰁨󰁥 󰁴󰁨󰁩󰁲󰁤 󰁤󰁥󰁡󰁴󰁨 󰁰󰁥󰁡󰁫 󰁯󰁣󰁣󰁵󰁲󰁳 󰁳󰁥󰁶󰁥󰁲󰁡󰁬 󰁤󰁡󰁹󰁳 󰁴󰁯 󰁷󰁥󰁥󰁫󰁳 󰁡󰁦󰁴󰁥󰁲 󰁴󰁨󰁥 󰁩󰁮󰁩󰁴󰁩󰁡󰁬 󰁩󰁮󰁪󰁵󰁲󰁹 S󰁥󰁰󰁳󰁩󰁳, MSOF .

Cr iter ia  ffor  t centr e :    tr ansfer  t  to  ttr auma  c ♣  M󰁵󰁬󰁴󰁩󰀭󰁳󰁹󰁳󰁴󰁥󰁭 . ♣  󰁕󰁮󰁳󰁴󰁡󰁢󰁬󰁥 . ♣  A󰁸󰁩󰁡󰁬 󰁳󰁫󰁥󰁬󰁥󰁴󰁯󰁮 󰁢󰁯󰁮󰁥 . ♣  󰁩󰁮󰁪󰁵󰁲󰁹 A󰁣󰁵󰁴󰁥 󰁣󰁯󰁲󰁤 󰁩󰁮󰁪󰁵󰁲󰁹 . . ♣  N󰁥󰁵󰁲󰁯󰁶󰁡󰁳󰁣󰁵󰁬󰁡󰁲 ♣  C󰁯󰁭󰁰󰁬󰁩󰁣󰁡󰁴󰁥󰁤 TBI . ♣  L󰁯󰁷 󰁴󰁲󰁡󰁵󰁭󰁡 󰁳󰁣󰁯󰁲󰁥 . 󰁥   2󰁼󰁐󰁡󰁧󰁥

 

Pediatric Trauma

S󰁕RG GP. 425

(Not Just Small Adults) Monday, Oct 29 2007

󰁄󰁲. 󰁁󰁡󰁹󰁥󰁤 󰁁󰁬󰀭󰁑 󰁡󰁨󰁴󰁡󰁮󰁩 󰁡󰁨󰁴󰁡󰁮󰁩  

󰁁󰁳󰁳. 󰁐󰁲󰁯󰁦󰁥󰁳󰁳󰁯󰁲 & 󰁃󰁯󰁮󰁳󰁵󰁬󰁴󰁡󰁮󰁴 󰁰󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣 󰁳󰁵󰁲󰁧󰁥󰁲󰁹

Tr auma  sscor es:   P󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣 T󰁲󰁡󰁵󰁭󰁡 S󰁣󰁯󰁲󰁥 (PTS) ♣ P󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣   A󰁣󰁣󰁵󰁲󰁡󰁴󰁥 󰁰󰁲󰁥󰁤󰁩󰁣󰁴󰁯󰁲 󰁯󰁦 󰁩󰁮󰁪󰁵󰁲󰁹 󰁳󰁥󰁶󰁥󰁲󰁩󰁴󰁹.   󰀭4 󰁴󰁯 12, <8 󰁩󰁮󰁣󰁲󰁥󰁡󰁳󰁥󰁤 󰁭󰁯󰁲󰁴󰁡󰁬󰁩󰁴󰁹.

R󰁥󰁶󰁩󰁳󰁥󰁤 T󰁲󰁡󰁵󰁭󰁡 S󰁣󰁯󰁲󰁥 (RTS) ♣ R󰁥󰁶󰁩󰁳󰁥󰁤   S󰁡󰁭󰁥 󰁡󰁳 󰁡󰁤󰁵󰁬󰁴󰁳 .   <12 󰁩󰁮󰁣󰁲󰁥󰁡󰁳󰁥󰁤 󰁭󰁯󰁲󰁴󰁡󰁬󰁩󰁴󰁹. ♣ I󰁮󰁪󰁵󰁲󰁹 I󰁮󰁪󰁵󰁲󰁹 S󰁥󰁶󰁥󰁲󰁩󰁴󰁹 S󰁣󰁯󰁲󰁥 (ISS)   C󰁵󰁭󰁢󰁥󰁲󰁳󰁯󰁭󰁥, 󰁵󰁮󰁤󰁥󰁲󰁥󰁳󰁴󰁩󰁭󰁡󰁴󰁥󰁳 󰁳󰁵󰁲󰁶󰁩󰁶󰁡󰁬.

Pediatric trauma score:   +2

+1

-1

Size (kg) >20 10-20 <10 SBP* >90 50-90 <50 Airway N Secure tenuous CNS awake obtund coma Open Wound none minor major Fractures none Closed Open *SBP=S󰁹󰁳󰁴󰁯󰁬󰁩󰁣 󰁢󰁬󰁯󰁯󰁤 󰁰󰁲󰁥󰁳󰁳󰁵󰁲󰁥 ♣  S󰁣󰁯󰁲󰁥 +12 󰁴󰁯 󰀭4 (󰁴󰁨󰁥 󰁲󰁡󰁮󰁧󰁥 󰁯󰁦 󰁴󰁨󰁥 󰁳󰁣󰁯󰁲󰁥). ♣  0% 󰁭󰁯󰁲󰁴󰁡󰁬󰁩󰁴󰁹 ≥ 8 (󰁭󰁥󰁡󰁮󰁩󰁮󰁧: 󰁴󰁨󰁥󰁲󰁥 󰁷󰁩󰁬󰁬 󰁢󰁥 󰁮󰁯 󰁭󰁯󰁲󰁴󰁡󰁬󰁩󰁴󰁹 󰁩󰁦 󰁴󰁨󰁥 󰁴󰁲󰁡󰁵󰁭󰁡 󰁳󰁣󰁯󰁲󰁥 󰁩󰁳 󰁭󰁯󰁲󰁥 󰁴󰁨󰁡󰁮 8). ♣  45% = 2 ♣  100% = 0 󰁵󰁰 󰁴󰁯 󰀭4 (󰁴󰁨󰁥󰁲󰁥 󰁷󰁩󰁬󰁬 󰁢󰁥 100% 󰁭󰁯󰁲󰁴󰁡󰁬󰁩󰁴󰁹 󰁩󰁦 󰁴󰁨󰁥 󰁴󰁲󰁡󰁵󰁭󰁡 󰁳󰁣󰁯󰁲󰁥 󰁩󰁳 󰁺󰁥󰁲󰁯). ♣  󰁴󰁲󰁡󰁮󰁳󰁦󰁥󰁲 󰁴󰁯 󰁰󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣 󰁴󰁲󰁡󰁵󰁭󰁡 󰁣󰁥󰁮󰁴󰁥󰁲 󰁩󰁦 PTS <8 .

Revised trauma score: Glasgow Coma Scale Score

Systolic Blood Pressure (mm Hg)

Respiratory Rate (breaths/ min)

Coded Value

13-15 9-12

>89 76-89

10 - 29 >29

10 3

6-8 4-5 3

50-75 1-49 0

6-9 1-5 0

2 1 0

*Gl asgow   coma   scale  is   similar   to   that   in   adults   but   with   BP   and   RR   added   to   it   in   pediatr ics.   Appr oach:   ♣  ATLS (A󰁤󰁶󰁡󰁮󰁣󰁥󰁤 T󰁲󰁡󰁵󰁭󰁡 L󰁩󰁦󰁥 S󰁵󰁰󰁰󰁯󰁲󰁴). ♣  󰁖󰁩󰁴󰁡󰁬 S󰁩󰁧󰁮󰁳: 󰁰󰁬󰁵󰁳, BP, 󰁴󰁥󰁭󰁰, 󰁷󰁥󰁩󰁧󰁨󰁴. ♣  󰁂󰁲󰁯󰁳󰁥󰁬󰁯󰁷   󰁴󰁡󰁰󰁥 (󰁡 󰁴󰁡󰁰󰁥 󰁦󰁯󰁲 󰁭󰁥󰁡󰁳󰁵󰁲󰁩󰁮󰁧 󰁨󰁥󰁩󰁧󰁨󰁴 󰁡󰁮󰁤 󰁷󰁥󰁩󰁧󰁨󰁴 󰁵󰁳󰁥󰁤 󰁷󰁨󰁥󰁮 󰁷󰁥 󰁣󰁡󰁮'󰁴 󰁣󰁡󰁲󰁲󰁹 󰁴󰁨󰁥 󰁰󰁡󰁴󰁩󰁥󰁮󰁴 󰁡󰁮󰁤 󰁷󰁥󰁩󰁧󰁨 󰁨󰁩󰁭/󰁨󰁥󰁲 󰁷󰁩󰁴󰁨 󰁡 󰁳󰁣󰁡󰁬󰁥 󰁬󰁩󰁫󰁥 󰁩󰁮 󰁥󰁭󰁥󰁲󰁧󰁥󰁮󰁣󰁩󰁥󰁳 󰁡󰁮󰁤 󰁧󰁩󰁶󰁥󰁳 󰁴󰁨󰁥 󰁲󰁥󰁱󰁵󰁩󰁲󰁥󰁤 󰁤󰁲󰁵󰁧 󰁤󰁯󰁳󰁥󰁳 󰁡󰁣󰁣󰁯󰁲󰁤󰁩󰁮󰁧 󰁴󰁯 󰁴󰁨󰁡󰁴.) ♣  ABC󰁳, C󰀭󰁳󰁰󰁩󰁮󰁥, NG 󰁴󰁵󰁢󰁥. ♣  C󰁯󰁮󰁳󰁥󰁮󰁴 (󰁩󰁮󰁣󰁡󰁳󰁥󰁳 󰁯󰁦 󰁴󰁨󰁥 󰁰󰁡󰁴󰁩󰁥󰁮󰁴'󰁳 󰁮󰁥󰁥󰁤 󰁦󰁯󰁲 󰁳󰁵󰁲󰁧󰁥󰁲󰁹).

󰁥   3󰁼󰁐󰁡󰁧󰁥

 

Pediatric Trauma (Not Just Small Adults)

S󰁕RG GP. 425

Monday, Oct 29 2007

󰁄󰁲. 󰁁󰁡󰁹󰁥󰁤 󰁁󰁬󰀭󰁑 󰁡󰁨󰁴󰁡󰁮󰁩 󰁡󰁨󰁴󰁡󰁮󰁩  

󰁁󰁳󰁳. 󰁐󰁲󰁯󰁦󰁥󰁳󰁳󰁯󰁲 & 󰁃󰁯󰁮󰁳󰁵󰁬󰁴󰁡󰁮󰁴 󰁰󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣 󰁳󰁵󰁲󰁧󰁥󰁲󰁹

Pr inciples  ::  󰁡󰁲󰁥 󰁲󰁥󰁡󰁬󰁬󰁹 󰁮󰁯󰁴 󰁪󰁵󰁳󰁴 󰁳󰁭󰁡󰁬󰁬 󰁡󰁤󰁵󰁬󰁴󰁳 󰁡󰁮󰁤 󰁴󰁨󰁥󰁲󰁥 ♣  K󰁩󰁤󰁳 󰁡󰁲󰁥 󰁤󰁩󰁦󰁦󰁥󰁲󰁥󰁮󰁣󰁥󰁳 󰁢󰁥󰁴󰁷󰁥󰁥󰁮 󰁴󰁨󰁥 󰁴󰁷󰁯. ♣  A󰁩󰁲󰁷󰁡󰁹 󰁡󰁮󰁤 󰁳󰁨󰁯󰁣󰁫 󰁭󰁡󰁮󰁡󰁧󰁥󰁭󰁥󰁮󰁴 󰁡󰁲󰁥 󰁶󰁥󰁲󰁹 󰁩󰁭󰁰󰁯󰁲󰁴󰁡󰁮󰁴. ♣  H󰁥󰁡󰁤 󰁩󰁮󰁪󰁵󰁲󰁹: ↑ 󰁭󰁯󰁲󰁢󰁩󰁤󰁩󰁴󰁹 & 󰁭󰁯󰁲󰁴󰁡󰁬󰁩󰁴󰁹. ♣  F󰁯󰁲󰁣󰁥󰁳 󰁯󰁶󰁥󰁲 󰁳󰁭󰁡󰁬󰁬 󰁡󰁲󰁥󰁡 →  󰁭󰁵󰁬󰁴󰁩󰀭󰁳󰁹󰁳󰁴󰁥󰁭󰁩󰁣 󰁩󰁮󰁪󰁵󰁲󰁹. ♣  L󰁩󰁴󰁴󰁬󰁥 󰁯󰁲 󰁮󰁯 󰁥󰁸󰁴󰁥󰁲󰁮󰁡󰁬 󰁩󰁮󰁪󰁵󰁲󰁹 󰁤󰁯󰁥󰁳 󰁮󰁯󰁴 󰁲󰁵󰁬󰁥 󰁡󰁮󰁹󰁴󰁨󰁩󰁮󰁧 󰁯󰁵󰁴. ♣  K󰁩󰁤󰁳 󰁤󰁩󰁥 󰁦󰁲󰁯󰁭 󰁨󰁹󰁰󰁯󰁸󰁩󰁡 󰁡󰁮󰁤 󰁲󰁥󰁳󰁰󰁩󰁲󰁡󰁴󰁯󰁲󰁹 󰁡󰁲󰁲󰁥󰁳󰁴 (*󰁶󰁥󰁲󰁹 󰁩󰁭󰁰󰁯󰁲󰁴󰁡󰁮󰁴, 󰁯󰁮󰁥 󰁯󰁦 󰁴󰁨󰁥 󰁣󰁯󰁭󰁭󰁯󰁮󰁥󰁳󰁴 󰁣󰁡󰁵󰁳󰁥󰁳). ♣  ↑  H󰁥󰁡󰁴 󰁬󰁯󰁳󰁳, 󰁧󰁬󰁵󰁣󰁯󰁳󰁥 & 󰁦󰁬󰁵󰁩󰁤 󰁲󰁥󰁱󰁵󰁩󰁲󰁥󰁭󰁥󰁮󰁴󰁳 (󰁨󰁹󰁰󰁯󰁴󰁨󰁥󰁲󰁭󰁩󰁡)   󰁶󰁥󰁲󰁹 󰁩󰁭󰁰. 󰁩󰁮 󰁰󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣 󰁴󰁲󰁡󰁵󰁭󰁡. ♣  P󰁳󰁹󰁣󰁨󰁥 󰁳󰁥󰁱󰁵󰁥󰁬.

Pr imar y  ssur vey:   󰁣󰁯󰁮󰁴󰁲󰁯󰁬: (󰁷󰁥 󰁫󰁮󰁯󰁷 󰁴󰁨󰁡󰁴 󰁡󰁩󰁲󰁷󰁡󰁹 󰁩󰁳 󰁣󰁬󰁥󰁡󰁲 󰁩󰁦 󰁴󰁨󰁥 ♣  A = A󰁩󰁲󰁷󰁡󰁹 󰁭󰁡󰁩󰁮󰁴󰁥󰁮󰁡󰁮󰁣󰁥 󰁷󰁩󰁴󰁨 󰁣󰁥󰁲󰁶󰁩󰁣󰁡󰁬 󰁳󰁰󰁩󰁮󰁥 󰁣󰁯󰁮󰁴󰁲󰁯󰁬: 󰁰󰁡󰁴󰁩󰁥󰁮󰁴 󰁷󰁡󰁳 󰁡󰁢󰁬󰁥 󰁴󰁯 󰁣󰁲󰁹 󰁯󰁲 󰁴󰁡󰁬󰁫 󰁩󰁦 󰁮󰁯󰁴 󰁴󰁨󰁥󰁮 󰁷󰁥 󰁩󰁮󰁴󰁵󰁢󰁡󰁴󰁥󰀬 󰁡󰁮󰁤 󰁩󰁮 󰁴󰁨󰁩󰁳 󰁳󰁴󰁥󰁰 󰁩󰁴 󰁩󰁳 󰁶󰁥󰁲󰁹 󰁩󰁭󰁰󰁯󰁲󰁴󰁡󰁮󰁴 󰁴󰁯 󰁰󰁲󰁯󰁴󰁥󰁣󰁴 󰁴󰁨󰁥 󰁃󰀭󰁳󰁰󰁩󰁮󰁥 󰁩󰁦 󰁩󰁮󰁪󰁵󰁲󰁥󰁤 󰁢󰁹 󰁩󰁮󰀭󰁬󰁩󰁮󰁥 󰁩󰁭󰁭󰁯󰁢󰁩󰁬󰁩󰁺󰁡󰁴󰁩󰁯󰁮 󰁷󰁨󰁥󰁲󰁥 󰁷󰁥 󰁭󰁯󰁢󰁩󰁬󰁩󰁺󰁥 󰁴󰁨󰁥 󰁳󰁰󰁩󰁮󰁥 󰁷󰁩󰁴󰁨󰁯󰁵󰁴 󰁡󰁮󰁹 󰁳󰁩󰁧󰁮󰁩󰁦󰁩󰁣󰁡󰁮󰁴 󰁦󰁬󰁥󰁸󰁩󰁯󰁮 󰁯󰁲 󰁥󰁸󰁴󰁥󰁮󰁳󰁩󰁯󰁮)󰀮   󰁶󰁥󰁮󰁴󰁩󰁬󰁡󰁴󰁩󰁯󰁮: (󰁢󰁹 󰁣󰁨󰁥󰁣󰁫󰁩󰁮󰁧 󰁴󰁨󰁥 󰁣󰁨󰁥󰁳󰁴 󰁭󰁯󰁶󰁥󰁭󰁥󰁮󰁴󰁳)󰀮  ♣  B = B󰁲󰁥󰁡󰁴󰁨󰁩󰁮󰁧 󰁡󰁮󰁤 󰁶󰁥󰁮󰁴󰁩󰁬󰁡󰁴󰁩󰁯󰁮: ♣  󰁃 󰀽 󰁃󰁩󰁲󰁣󰁵󰁬󰁡󰁴󰁩󰁯󰁮 󰁷󰁩󰁴󰁨 󰁨󰁥󰁭󰁯󰁲󰁲󰁨󰁡󰁧󰁥 󰁣󰁯󰁮󰁴󰁲󰁯󰁬󰀺 󰁣󰁯󰁮󰁴󰁲󰁯󰁬󰀺 (󰁢󰁹 󰁣󰁨󰁥󰁣󰁫󰁩󰁮󰁧 󰁴󰁨󰁥 󰁰󰁵󰁬󰁳󰁥 󰁡󰁮󰁤 󰁂󰁐 󰁡󰁮󰁤 󰁲󰁥󰁳󰁵󰁳󰁣󰁩󰁴󰁡󰁴󰁥󰁤 󰁢󰁹 󰁴󰁷󰁯 󰁉󰁖 󰁡󰁣󰁣󰁥󰁳󰁳 󰁬󰁩󰁮󰁥󰁳)󰀮  󰀭󰁷󰁨󰁥󰁮 󰁉'󰁭 󰁡󰁢󰁬󰁥 󰁴󰁯 󰁰󰁡󰁬󰁰󰁡󰁴󰁥 󰁴󰁨󰁥 󰁲󰁡󰁤󰁩󰁡󰁬 󰁰󰁵󰁬󰁳󰁥 󰁴󰁨󰁥󰁮 󰁴󰁨󰁥 󰁓󰁂󰁐 󰁩󰁳 󰁵󰁳󰁵󰁡󰁬󰁬󰁹 󰁭󰁩󰁮󰁩󰁭󰁡󰁬󰁬󰁹 󰀹0. 󰀭󰁩󰁦 󰁲󰁡󰁤󰁩󰁡󰁬 󰁰󰁵󰁬󰁳󰁥 󰁩󰁳 󰁮󰁯󰁴 󰁰󰁡󰁬󰁰󰁡󰁢󰁬󰁥 󰁡󰁮󰁤 󰁦󰁥󰁭󰁯󰁲󰁡󰁬 󰁰󰁵󰁬󰁳󰁥 󰁩󰁳 󰁴󰁨󰁥󰁮 󰁓󰁂󰁐 󰁩󰁳 󰁵󰁳󰁵󰁡󰁬󰁬󰁹 󰀸0. 󰀭󰁩󰁦 󰁣󰁡󰁮󰁮󰁯󰁴 󰁢󰁥 󰁦󰁥󰁬󰁴 󰁩󰁮 󰁦󰁥󰁭󰁯󰁲󰁡󰁬 󰁢󰁵󰁴 󰁩󰁳 󰁰󰁡󰁬󰁰󰁡󰁢󰁬󰁥 󰁩󰁮 󰁣󰁡󰁲󰁯󰁴󰁩󰁤 󰁴󰁨󰁥󰁮 󰁓󰁂󰁐 󰁩󰁳 󰁵󰁳󰁵󰁡󰁬󰁬󰁹 60 (60 󰁩󰁳 󰁶󰁥󰁲󰁹 󰁬󰁯󰁷 󰁡󰁮󰁤 󰁴󰁨󰁥 󰁰󰁡󰁴󰁩󰁥󰁮󰁴 󰁭󰁡󰁹 󰁧󰁯 󰁩󰁮󰁴󰁯 󰁡󰁮 󰁡󰁲󰁲󰁥󰁳󰁴).

♣  D = D󰁩󰁳󰁡󰁢󰁩󰁬󰁩󰁴󰁹: D󰁩󰁳󰁡󰁢󰁩󰁬󰁩󰁴󰁹: 󰁮󰁥󰁵󰁲󰁯󰁬󰁯󰁧󰁩󰁣 󰁳󰁴󰁡󰁴󰁵󰁳 (A󰁖P󰁕= A󰁬󰁥󰁲󰁴, 󰁖󰁥󰁲󰁢󰁡󰁬 󰁳󰁴󰁩󰁭󰁵󰁬󰁩 󰁲󰁥󰁳󰁰󰁯󰁮󰁳󰁥, P󰁡󰁩󰁮󰁦󰁵󰁬 󰁳󰁴󰁩󰁭󰁵󰁬󰁩 󰁲󰁥󰁳󰁰󰁯󰁮󰁳󰁥, 󰁕󰁮󰁲󰁥󰁳󰁰󰁯󰁮󰁳󰁩󰁶󰁥). 󰁣󰁯󰁮󰁴󰁲󰁯󰁬: 󰁣󰁯󰁭󰁰󰁬󰁥󰁴󰁥󰁬󰁹 󰁵󰁮󰁤󰁲󰁥󰁳󰁳 󰁴󰁨󰁥 󰁰󰁡󰁴󰁩󰁥󰁮󰁴, 󰁢󰁵󰁴 󰁰󰁲󰁥󰁶󰁥󰁮󰁴 󰁨󰁹󰁰󰁯󰁴󰁨󰁥󰁲󰁭󰁩󰁡 . ♣  E = E󰁸󰁰󰁯󰁳󰁵󰁲󰁥/ E󰁮󰁶󰁩󰁲󰁯󰁮󰁭󰁥󰁮󰁴󰁡󰁬 󰁣󰁯󰁮󰁴󰁲󰁯󰁬: 󰁣󰁯󰁭󰁰󰁬󰁥󰁴󰁥󰁬󰁹

󰁥   4󰁼󰁐󰁡󰁧󰁥

 

Pediatric Trauma (Not Just Small Adults)

S󰁕RG GP. 425

Monday, Oct 29 2007

󰁄󰁲. 󰁁󰁡󰁹󰁥󰁤 󰁁󰁬󰀭󰁑 󰁡󰁨󰁴󰁡󰁮󰁩 󰁡󰁨󰁴󰁡󰁮󰁩  

󰁁󰁳󰁳. 󰁐󰁲󰁯󰁦󰁥󰁳󰁳󰁯󰁲 & 󰁃󰁯󰁮󰁳󰁵󰁬󰁴󰁡󰁮󰁴 󰁰󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣 󰁳󰁵󰁲󰁧󰁥󰁲󰁹

Air way  ::   ♣  2 󰁸 O2 󰁤󰁥󰁭󰁡󰁮󰁤󰁳 (󰁵󰁳󰁵󰁡󰁬󰁬󰁹 󰁷󰁥 󰁰󰁵󰁴 󰁴󰁨󰁥󰁭 󰁯󰁮 100% 󰁯󰁸󰁹󰁧󰁥󰁮 󰁴󰁯 󰁳󰁴󰁡󰁲󰁴 󰁷󰁩󰁴󰁨). ♣  󰁲󰁥󰁳󰁰󰁩󰁲󰁡󰁴󰁯󰁲󰁹 󰁦󰁡󰁩󰁬󰁵󰁲󰁥 #1 󰁣󰁡󰁵󰁳󰁥 󰁯󰁦 󰁡󰁲󰁲󰁥󰁳󰁴 . 󰁥󰁸󰁥󰁰󰁴󰁡󰁢󰁬󰁥 󰁩󰁳 󰁰󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣󰁳), 󰁰󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣󰁳), ♣  󰁮󰁯 󰁳󰁵󰁲󰁧󰁩󰁣󰁡󰁬 󰁡󰁩󰁲󰁷󰁡󰁹 < 10󰁹󰁥󰁡󰁲󰁳 󰁩.󰁥. 󰁴󰁲󰁡󰁣󰁨󰁩󰁡󰁳󰁴󰁯󰁭󰁹 (󰁳󰁯󰁭󰁥󰁴󰁩󰁭󰁥󰁳 󰁩󰁴 󰁩󰁳 󰁥󰁸󰁥󰁰󰁴󰁡󰁢󰁬󰁥 󰁣󰁲󰁩󰁣󰁯󰁴󰁨󰁹󰁲󰁯󰁤󰁯󰁴󰁯󰁭󰁹 (󰁢󰁥󰁣󰁡󰁵󰁳󰁥 󰁩󰁮 󰁰󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣󰁳 󰁴󰁨󰁥 󰁣󰁲󰁩󰁣󰁯󰁴󰁨󰁹󰁲󰁯󰁩󰁤 󰁭󰁥󰁭󰁢󰁲󰁡󰁮󰁥 󰁩󰁳 󰁶󰁥󰁲󰁹 󰁳󰁭󰁡󰁬󰁬 󰁩󰁦 󰁷󰁥 󰁤󰁯 󰁴󰁨󰁩󰁳 󰁣󰁵󰁴 󰁷󰁥 󰁷󰁩󰁬󰁬 󰁩󰁮󰁪󰁵󰁲󰁥 󰁴󰁨󰁥 󰁣󰁲󰁩󰁣󰁯󰁩󰁤󰁳 󰁯󰁲 󰁴󰁨󰁥 󰁬󰁡󰁲󰁹󰁮󰁸), . ♣  E󰁮󰁤󰁯󰁴󰁲󰁡󰁣󰁨󰁥󰁡󰁬 󰁴󰁵󰁢󰁥 (ET 󰁴󰁵󰁢󰁥) 󰁳󰁩󰁺󰁥: 󰁦󰁯󰁲 󰁣󰁡󰁬󰁣󰁵󰁬󰁡󰁴󰁩󰁯󰁮 󰁯󰁦 󰁴󰁨󰁥 󰁴󰁵󰁢󰁥 󰁳󰁩󰁺󰁥 󰁷󰁥 󰁤󰁯 󰁴󰁨󰁥 󰁦󰁯󰁬󰁬󰁯󰁷󰁩󰁮󰁧 󰁦󰁯󰁲󰁭󰁵󰁬󰁡: (16 + 󰁡󰁧󰁥)/4 . ♣  L󰁡󰁲󰁹󰁮󰁧󰁥󰁡󰁬 M󰁡󰁳󰁫 A󰁩󰁲󰁷󰁡󰁹 (LMA) 󰁡󰁳 󰁲󰁥󰁳󰁣󰁵󰁥 󰁩󰁦 >4 󰁦󰁥󰁥󰁴 󰁴󰁡󰁬󰁬 (󰁵󰁳󰁥󰁤 󰁦󰁯󰁲 󰁶󰁥󰁮󰁴󰁩󰁬󰁡󰁴󰁩󰁯󰁮 󰁡󰁮󰁤 󰁴󰁯 󰁡󰁣󰁣󰁥󰁳󰁳 󰁴󰁨󰁥 󰁡󰁩󰁲󰁷󰁡󰁹).

Anatomical  a air way  iissues  iin  k  k ids:  ♣  B󰁩󰁧 󰁴󰁯󰁮󰁧󰁵󰁥, 󰁳󰁯󰁦󰁴 󰁴󰁩󰁳󰁳󰁵󰁥 → 󰁯󰁢󰁳󰁴󰁲󰁵󰁣󰁴󰁩󰁯󰁮. ♣  S󰁯󰁦󰁴 󰁴󰁲󰁡󰁣󰁨󰁥󰁡  󰁮󰁯 󰁣󰁵󰁦󰁦 (󰁵󰁳󰁵󰁡󰁬󰁬󰁹 󰁮󰁯󰁴 󰁵󰁳󰁥󰁤 󰁢󰁥󰁬󰁯󰁷 8 󰁹󰁥󰁡󰁲󰁳 󰁯󰁬󰁤 󰁢󰁥󰁣󰁡󰁵󰁳󰁥 󰁩󰁴 󰁭󰁡󰁹 󰁣󰁡󰁵󰁳󰁥 󰁴󰁲󰁡󰁣󰁨󰁥󰁡󰁬 󰁤󰁡󰁭󰁡󰁧󰁥 󰁡󰁮󰁤 󰁩󰁳󰁣󰁨󰁥󰁭󰁩󰁡 󰁤󰁵󰁥 󰁴󰁯 󰁣󰁯󰁭󰁰󰁲󰁥󰁳󰁳󰁩󰁮󰁧 󰁴󰁨󰁥 󰁶󰁥󰁳󰁳󰁥󰁬󰁳 󰁴󰁨󰁥󰁲󰁥). ♣  S󰁯󰁦󰁴 󰁖󰁯󰁣󰁡󰁬 C󰁯󰁲󰁤  󰁮󰁯 󰁳󰁴󰁹󰁬󰁥󰁴 󰁵󰁳󰁥󰁤 (󰁳󰁴󰁹󰁬󰁥󰁴: 󰁩󰁳 󰁴󰁨󰁥 󰁴󰁯󰁯󰁬 󰁳󰁥󰁤 󰁦󰁯󰁲 󰁧󰁵󰁩󰁤󰁩󰁮󰁧 󰁴󰁨󰁥 󰁴󰁵󰁢󰁥 󰁩󰁮󰁴󰁯 󰁴󰁨󰁥 󰁬󰁡󰁲󰁹󰁮󰁸, 󰁢󰁵󰁴 󰁩󰁦 󰁵󰁳󰁥󰁤 󰁨󰁥󰁲󰁥 󰁭󰁡󰁹 󰁩󰁮󰁪󰁵󰁲󰁥 󰁴󰁨󰁥 󰁬󰁡󰁲󰁹󰁮󰁸). ♣  A󰁮󰁴󰁥󰁲󰁩󰁯󰁲 󰁬󰁡󰁲󰁹󰁮󰁸. ♣  󰁳󰁨󰁯󰁲󰁴 󰁴󰁲󰁡󰁣󰁨󰁥󰁡 . ♣  󰁮󰁡󰁲󰁲󰁯󰁷󰁥󰁳󰁴 󰁰󰁡󰁲󰁴 󰁯󰁦 󰁴󰁲󰁡󰁣󰁨󰁥󰁡 󰁩󰁳 󰁡󰁴 󰁳󰁵󰁢󰁧󰁬󰁯󰁴󰁴󰁩󰁳 . ♣  󰁮󰁯󰁳󰁥 󰁢󰁲󰁥󰁡󰁴󰁨󰁥󰁲󰁳 < 6 󰁭󰁯󰁮󰁴󰁨󰁳 . ♣  󰁢󰁩󰁧 󰁯󰁣󰁣󰁩󰁰󰁵󰁴 (󰁳󰁯 󰁴󰁨󰁥󰁲󰁥 󰁭󰁡󰁹 󰁢󰁥 󰁡 󰁳󰁰󰁩󰁮󰁡󰁬 󰁩󰁮󰁪󰁵󰁲󰁹) ♣  󰁢󰁩󰁧 󰁥󰁰󰁩󰁧󰁬󰁯󰁴󰁴󰁩󰁳 󰁴󰁨󰁡󰁴 󰁭󰁡󰁹 󰁯󰁢󰁳󰁴󰁲󰁵󰁣󰁴 󰁴󰁨󰁥 󰁬󰁡󰁲󰁹󰁮󰁸 󰁷󰁨󰁩󰁬󰁥 󰁩󰁮󰁴󰁵󰁢󰁡󰁴󰁩󰁯󰁮  󰁳󰁯 󰁷󰁥 󰁵󰁳󰁥 󰁡 󰁳󰁴󰁲󰁡󰁩󰁧󰁨󰁴 󰁢󰁬󰁡󰁤󰁥 󰁴󰁯 󰁥󰁬󰁥󰁶󰁡󰁴󰁥 󰁴󰁨󰁥 󰁥󰁰󰁩󰁧󰁬󰁯󰁴󰁴󰁩󰁳 .

󰁥   5󰁼󰁐󰁡󰁧󰁥

 

Pediatric Trauma (Not Just Small Adults)

S󰁕RG GP. 425

Monday, Oct 29 2007

󰁄󰁲. 󰁁󰁡󰁹󰁥󰁤 󰁁󰁬󰀭󰁑 󰁡󰁨󰁴󰁡󰁮󰁩 󰁡󰁨󰁴󰁡󰁮󰁩  

󰁁󰁳󰁳. 󰁐󰁲󰁯󰁦󰁥󰁳󰁳󰁯󰁲 & 󰁃󰁯󰁮󰁳󰁵󰁬󰁴󰁡󰁮󰁴 󰁰󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣 󰁳󰁵󰁲󰁧󰁥󰁲󰁹

󰁐󰁥󰁤󰁩󰁡󰁴 󰁲󰁩󰁣 󰁁󰁩󰁲󰁷󰁡󰁹  

RSI:  (the  d docto r  d mention  tth s  didn’t  m  i s subtitle )   ♣  P󰁲󰁥󰀭󰁴󰁲󰁥󰁡󰁴 󰁡󰁴󰁲󰁯󰁰󰁩󰁮󰁥 󰁡󰁴󰁲󰁯󰁰󰁩󰁮󰁥 0.02  0.02 󰁭󰁧/󰁫󰁧 󰁡󰁬󰁬 < 6󰁹󰁥󰁡󰁲󰁳 . ♣  󰁮󰁯 󰁤󰁥󰁦󰁡󰁳󰁣󰁩󰁣󰁵󰁬󰁡󰁴󰁩󰁮󰁧 󰁤󰁯󰁳󰁥 < 5 󰁹󰁥󰁡󰁲󰁳 . ♣  󰁩󰁮󰁤󰁵󰁣󰁴󰁩󰁯󰁮:   󰁫󰁥󰁴󰁡󰁭󰁩󰁮󰁥 󰁫󰁥󰁴󰁡󰁭󰁩󰁮󰁥 1󰀭2  1󰀭2 󰁭󰁧/󰁫󰁧   󰁭󰁩󰁤󰁡󰁺 󰁭󰁩󰁤󰁡󰁺 0.2󰀭0.3  0.2󰀭0.3 󰁭󰁧/󰁫󰁧   󰁰󰁲󰁯󰁰󰁯󰁦󰁯󰁬  2  2 󰁭󰁧/󰁫󰁧   󰁴󰁨󰁩󰁯󰁰󰁥󰁮󰁴󰁡󰁬  3󰀭7  3󰀭7 󰁭󰁧/󰁫󰁧   󰁥󰁴󰁯󰁭󰁩󰁤󰁡󰁴󰁥 󰁥󰁴󰁯󰁭󰁩󰁤󰁡󰁴󰁥 0.3  0.3 󰁭󰁧/󰁫󰁧  2 󰁭󰁧/󰁫󰁧 ♣  󰁳󰁵󰁸  2 ♣  󰁮󰁯 󰁥󰁶󰁩󰁤󰁥󰁮󰁣󰁥 󰁦󰁯󰁲 󰁬󰁩󰁤󰁯󰁣󰁡󰁩󰁮󰁥 󰁬󰁩󰁤󰁯󰁣󰁡󰁩󰁮󰁥 󰁩󰁮  󰁩󰁮 󰁫󰁩󰁤󰁳 .

Br eathing  ::   ♣  S󰁩󰁧󰁮󰁳 󰁯󰁦 󰁲󰁥󰁳󰁰󰁩󰁲󰁡󰁴󰁯󰁲󰁹 󰁤󰁩󰁳󰁴󰁲󰁥󰁳󰁳: 󰁩󰁮󰁤󰁲󰁡󰁷󰁩󰁮󰁧, 󰁴󰁲󰁡󰁣󰁨󰁥󰁡󰁬 󰁴󰁵󰁧, 󰁮󰁡󰁳󰁡󰁬 󰁦󰁬󰁡󰁲󰁩󰁮󰁧, 󰁴󰁡󰁣󰁨󰁹󰁣󰁡󰁲󰁤󰁩󰁡󰁣, 󰁴󰁡󰁣󰁨󰁹󰁰󰁮󰁩󰁣, 󰁵󰁳󰁥 󰁯󰁦 󰁡󰁣󰁣󰁥󰁳󰁳󰁯󰁲󰁹 󰁲󰁥󰁳󰁰󰁩󰁲󰁡󰁴󰁯󰁲󰁹 󰁭󰁵󰁳󰁣󰁬󰁥󰁳. ♣  󰁩󰁮󰁦󰁡󰁮󰁴󰁳:   I󰁭󰁭󰁡󰁴󰁵󰁲󰁥 󰁲󰁥󰁳󰁰󰁯󰁮󰁳󰁥 󰁴󰁯 󰁨󰁹󰁰󰁯󰁸󰁩󰁡 (󰁴󰁨󰁥󰁹 󰁤󰁯󰁮󲀙󰁴 󰁴󰁯󰁬󰁥󰁲󰁡󰁴󰁥 󰁩󰁴 󰁶󰁥󰁲󰁹 󰁷󰁥󰁬󰁬).   D󰁩󰁡󰁰󰁨󰁲󰁡󰁧󰁭 1󰂰 󰁲󰁥󰁳󰁰󰁩󰁲󰁡󰁴󰁯󰁲󰁹 󰁭󰁵󰁳󰁣󰁬󰁥   󰁅󰁡󰁳󰁩󰁬󰁹 󰁦󰁡󰁴󰁩󰁧󰁵󰁥󰁤.   󰁡󰁥󰁲󰁯󰁰󰁨󰁡󰁧󰁩󰁡 󰁤󰁩󰁳󰁰󰁬󰁡󰁣󰁥󰁳 󰁤󰁩󰁡󰁰󰁨󰁲󰁡󰁧󰁭. ♣  T󰁨󰁯󰁲󰁡󰁣󰁩󰁣 󰁳󰁴󰁲󰁵󰁣󰁴󰁵󰁲󰁥󰁳 󰁡󰁮󰁤 󰁭󰁥󰁤󰁩󰁡󰁳󰁴󰁩󰁮󰁵󰁭 󰁩󰁳 󰁭󰁯󰁢󰁩󰁬󰁥 → 󰁳󰁨󰁩󰁦󰁴.

Chest ttr auma ::  ♣  2󰁮󰁤 󰁬󰁥󰁡󰁤󰁩󰁮󰁧 󰁣󰁡󰁵󰁳󰁥 󰁯󰁦 󰁰󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣 󰁴󰁲󰁡󰁵󰁭󰁡 󰁤󰁥󰁡󰁴󰁨. (󰁷󰁨󰁥󰁲󰁥 󰁨󰁥󰁡󰁤 󰁩󰁮󰁪󰁵󰁲󰁹 󰁩󰁳 󰁴󰁨󰁥 󰁦󰁩󰁲󰁳󰁴 󰁣󰁡󰁵󰁳󰁥.) ♣  C󰁯󰁭󰁰󰁬󰁩󰁡󰁮󰁴 󰁣󰁨󰁥󰁳󰁴 󰁷󰁡󰁬󰁬 (  ‫دو‬  )∴ 󰁲󰁩󰁢 󰁢󰁯󰁮󰁥 󰁵󰁮󰁣󰁯󰁭󰁭󰁯󰁮  S󰁩󰁧󰁮󰁩󰁦󰁩󰁣󰁡󰁮󰁴 S󰁩󰁧󰁮󰁩󰁦󰁩󰁣󰁡󰁮󰁴 󰁩󰁮󰁪󰁵󰁲󰁩󰁥󰁳 󰁷󰁩󰁴󰁨󰁯󰁵󰁴 󰁥󰁸󰁴󰁥󰁲󰁮󰁡󰁬 󰁳󰁩󰁧󰁮󰁳.  I󰁦 I󰁦 󰁴󰁨󰁥 󰁢󰁯󰁮󰁥 󰁦󰁲󰁡󰁣󰁴󰁵󰁲󰁥 󰁩󰁳 󰁰󰁲󰁥󰁳󰁥󰁮󰁴, 󰁴󰁨󰁩󰁳 󰁩󰁮󰁤󰁩󰁣󰁡󰁴󰁥󰁳 󰁳󰁥󰁶󰁥󰁲󰁥 󰁩󰁮󰁪󰁵󰁲󰁹. ♣  M󰁯󰁢󰁩󰁬󰁩󰁴󰁹 󰁯󰁦 󰁭󰁥󰁤󰁩󰁡󰁳󰁴󰁥󰁲󰁮󰁡󰁬 󰁳󰁴󰁲󰁵󰁣󰁴󰁵󰁲󰁥󰁳 󰁭󰁯󰁲󰁥 󰁳󰁥󰁮󰁳󰁩󰁴󰁩󰁶󰁥 󰁴󰁯 󰁴󰁥󰁮󰁳󰁩󰁯󰁮 󰁰󰁮󰁥󰁵󰁭󰁯󰁴󰁨󰁯󰁲󰁡󰁣󰁥󰁳 󰁡󰁮󰁤 󰁦󰁬󰁡󰁩󰁬 󰁳󰁥󰁧󰁭󰁥󰁮󰁴󰁳 󰁯󰁲 󰁦󰁬󰁡󰁩󰁬 󰁣󰁨󰁥󰁳󰁴 (󰁷󰁨󰁥󰁮 󰁰󰁡󰁲󰁴 󰁯󰁦 󰁴󰁨󰁥 󰁣󰁨󰁥󰁳󰁴 󰁩󰁳 󰁭󰁯󰁶󰁩󰁮󰁧 󰁩󰁮 󰁴󰁨󰁥 󰁯󰁰󰁰󰁯󰁳󰁩󰁴󰁥 󰁤󰁩󰁲󰁥󰁣󰁴󰁩󰁯󰁮 󰁷󰁨󰁩󰁬󰁥 󰁢󰁲󰁥󰁡󰁴󰁨󰁩󰁮󰁧 󰁤󰁵󰁥 󰁴󰁯 󰁮󰁥󰁧󰁡󰁴󰁩󰁶󰁥 󰁰󰁲󰁥󰁳󰁳󰁵󰁲󰁥 󰁣󰁡󰁵󰁳󰁩󰁮󰁧 󰁳󰁵󰁣󰁫󰁩󰁮󰁧 󰁩.󰁥. 󰁴󰁨󰁥 󰁣󰁨󰁥󰁳󰁴 󰁭󰁯󰁶󰁥󰁳 󰁩󰁮󰁷󰁡󰁲󰁤󰁳 󰁷󰁩󰁴󰁨 󰁩󰁮󰁨󰁡󰁬󰁡󰁴󰁩󰁯󰁮 󰁡󰁮󰁤 󰁯󰁵󰁴󰁷󰁡󰁲󰁤󰁳 󰁷󰁩󰁴󰁨 󰁥󰁸󰁨󰁡󰁬󰁡󰁴󰁩󰁯󰁮. F󰁯󰁲 󰁥󰁸󰁡󰁭󰁰󰁬󰁥 󰁷󰁨󰁥󰁮 󰁴󰁨󰁥󰁲󰁥 󰁡󰁲󰁥 󰁡󰁴 󰁬󰁥󰁡󰁳󰁴 3 󰁲󰁩󰁢󰁳 󰁢󰁲󰁯󰁫󰁥󰁮 󰁯󰁮 󰁥󰁡󰁣󰁨 󰁳󰁩󰁤󰁥 󰁯󰁦 󰁴󰁨󰁥 󰁣󰁡󰁧󰁥, 󰁴󰁨󰁥󰁹 󰁷󰁩󰁬󰁬 󰁢󰁥 󰁦󰁬󰁡󰁩󰁬 󰁳󰁥󰁧󰁭󰁥󰁮󰁴󰁳.

♣ 

T󰁲󰁥󰁡󰁴 󰁣󰁯󰁮󰁳󰁥󰁲󰁶󰁡󰁴󰁩󰁶󰁥󰁬󰁹:  15% 15% 󰁲󰁥󰁱󰁵󰁩󰁲󰁥 󰁭󰁯󰁲󰁥 󰁴󰁨󰁡󰁮 󰁣󰁨󰁥󰁳󰁴 󰁴󰁵󰁢󰁥. ♣  P󰁵󰁬󰁭󰁯󰁮󰁡󰁲󰁹 󰁣󰁯󰁮󰁴󰁵󰁳󰁩󰁯󰁮 󰁩󰁳 󰁭󰁯󰁳󰁴 󰁣󰁯󰁭󰁭󰁯󰁮, 󰁡󰁯󰁲󰁴󰁩󰁣 󰁩󰁮󰁪󰁵󰁲󰁹 󰁩󰁳 󰁲󰁡󰁲󰁥.

󰁥   6󰁼󰁐󰁡󰁧󰁥

 

Pediatric Trauma (Not Just Small Adults)

S󰁕RG GP. 425

Monday, Oct 29 2007

󰁄󰁲. 󰁁󰁡󰁹󰁥󰁤 󰁁󰁬󰀭󰁑 󰁡󰁨󰁴󰁡󰁮󰁩 󰁡󰁨󰁴󰁡󰁮󰁩  

󰁁󰁳󰁳. 󰁐󰁲󰁯󰁦󰁥󰁳󰁳󰁯󰁲 & 󰁃󰁯󰁮󰁳󰁵󰁬󰁴󰁡󰁮󰁴 󰁰󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣 󰁳󰁵󰁲󰁧󰁥󰁲󰁹

Life thr eatening  thor acic  in j ju ur ies:   ♣  T󰁥󰁮󰁳󰁩󰁯󰁮 󰁰󰁮󰁥󰁵󰁭󰁯󰁴󰁨󰁯󰁲󰁡󰁸: 󰁩󰁳 󰁡 󰁰󰁮󰁥󰁵󰁭󰁯󰁴󰁨󰁯󰁲󰁡󰁸 󰁣󰁡󰁵󰁳󰁩󰁮󰁧 󰁨󰁥󰁡󰁭󰁯󰁤󰁩󰁮󰁡󰁭󰁩󰁣󰁡󰁬 󰁩󰁮󰁳󰁴󰁡󰁢󰁩󰁬󰁩󰁴󰁹 (󰁴󰁡󰁣󰁨󰁹󰁣󰁡󰁲󰁤󰁩󰁡, 󰁨󰁹󰁰󰁯󰁴󰁥󰁮󰁴󰁩󰁯󰁮, 󰁳󰁨󰁩󰁦󰁴󰁩󰁮󰁧 󰁯󰁦 󰁭󰁥󰁤󰁩󰁡󰁳󰁴󰁩󰁮󰁵󰁭󲀦).

♣  M󰁡󰁳󰁳󰁩󰁶󰁥 󰁨󰁥󰁭󰁯󰁴󰁨󰁯󰁲󰁡󰁸 ♣  C󰁡󰁲󰁤󰁩󰁡󰁣 󰁴󰁹󰁭󰁰󰁯󰁮󰁡󰁤󰁥: 󰁦󰁬󰁵󰁩󰁤 󰁩󰁮 󰁴󰁨󰁥 󰁰󰁥󰁲󰁩󰁣󰁡󰁲󰁤󰁩󰁵󰁭. ♣  F󰁬󰁡󰁩󰁬 󰁣󰁨󰁥󰁳󰁴.

󰁥   7󰁼󰁐󰁡󰁧󰁥

 

Pediatric Trauma (Not Just Small Adults)

S󰁕RG GP. 425

Monday, Oct 29 2007

󰁄󰁲. 󰁁󰁡󰁹󰁥󰁤 󰁁󰁬󰀭󰁑 󰁡󰁨󰁴󰁡󰁮󰁩 󰁡󰁨󰁴󰁡󰁮󰁩  

󰁁󰁳󰁳. 󰁐󰁲󰁯󰁦󰁥󰁳󰁳󰁯󰁲 & 󰁃󰁯󰁮󰁳󰁵󰁬󰁴󰁡󰁮󰁴 󰁰󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣 󰁳󰁵󰁲󰁧󰁥󰁲󰁹

Cir culation:   ♣  L󰁯󰁷 BP 󰁩󰁳 󰁡 LATE 󰁳󰁩󰁧󰁮: 󰁫󰁩󰁤󰁳 󰁣󰁯󰁭󰁰󰁥󰁮󰁳󰁡󰁴󰁥 󰁷󰁥󰁬󰁬 󰁢󰁵󰁴 󰁤󰁲󰁯󰁰 󰁶󰁥󰁲󰁹 󰁱󰁵󰁩󰁣󰁫󰁬󰁹 󰁡󰁦󰁴󰁥󰁲 󰁴󰁨󰁡󰁴.   ≥ 25% 󰁬󰁯󰁳󰁳 󰁯󰁦 󰁢󰁬󰁯󰁯󰁤 󰁶󰁯󰁬󰁵󰁭󰁥 󰁩󰁮 󰁯󰁲󰁤󰁥󰁲 󰁴󰁯 󰁨󰁡󰁶󰁥 BP 󰁰󰁲󰁯󰁢󰁬󰁥󰁭󰁳.   M󰁩󰁮󰁩󰁭󰁵󰁭 󰁡󰁣󰁣󰁥󰁰󰁴󰁡󰁢󰁬󰁥 BP: 70 + (2 󰁸 󰁡󰁧󰁥). ♣  E󰁡󰁲󰁬󰁹 S󰁩󰁧󰁮󰁳 󰁯󰁦 󰁳󰁨󰁯󰁣󰁫: ↑HR, ↓RR, 󰁭󰁯󰁴󰁴󰁬󰁥󰁤         ‫ زي‬  ‫ا‬      ‫) ا‬ (‫ا‬  , 󰁣󰁯󰁯󰁬, ↓󰁰󰁵󰁬󰁳󰁥󰁳, 󰁡󰁬󰁴󰁥󰁲󰁥󰁤 LOC, 󰁣󰁡󰁰 󰁲󰁥󰁦󰁩󰁬󰁬 > 2 󰁳󰁥󰁣 (󰁰󰁲󰁯󰁬󰁯󰁮󰁧󰁥󰁤). ♣  S󰁣󰁡󰁬󰁰 󰁬󰁡󰁣󰁥󰁲󰁡󰁴󰁩󰁯󰁮 󰁣󰁡󰁮 󰁣󰁡󰁵󰁳󰁥 󰁳󰁨󰁯󰁣󰁫 󰁩󰁮 󰁰󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣󰁳 󰁯󰁮󰁬󰁹 󰁡󰁮󰁤 󰁮󰁯󰁴 󰁩󰁮 󰁡󰁤󰁵󰁬󰁴󰁳 (󰁤󰁵󰁥 󰁴󰁯 󰁨󰁩󰁧󰁨 󰁳󰁵󰁲󰁦󰁡󰁣󰁥 󰁡󰁲󰁥󰁡 󰁩󰁮 󰁴󰁨󰁥 󰁨󰁥󰁡󰁤 󰁡󰁮󰁤 󰁨󰁩󰁧󰁨 󰁢󰁬󰁯󰁯󰁤 󰁳󰁵󰁰󰁰󰁬󰁹). ♣  M󰁡󰁮󰁡󰁧󰁥󰁭󰁥󰁮󰁴 󰁢󰁹 I󰁖 󰁬󰁩󰁮󰁥󰁳: 󰁡󰁮󰁴󰁥󰁣󰁵󰁢󰁩󰁴󰁡󰁬, 󰁦󰁥󰁭󰁯󰁲󰁡󰁬, 󰁥󰁸󰁴󰁥󰁲󰁮󰁡󰁬 󰁪󰁵󰁧󰁵󰁬󰁡󰁲. ♣  A󰁴󰁴󰁥󰁭󰁰󰁴 <90 󰁳󰁥󰁣, 󰁴󰁨󰁥󰁮 󰁩󰁮󰁴󰁲󰁡󰁯󰁳󰁳󰁥󰁯󰁵󰁳 (󰁡 󰁲󰁩󰁧󰁩󰁤 󰁮󰁥󰁥󰁤󰁬󰁥 󰁴󰁨󰁡󰁴 󰁷󰁥 󰁰󰁡󰁳󰁳 󰁴󰁯 󰁴󰁨󰁥 󰁢󰁯󰁮󰁥 󰁭󰁡󰁲󰁲󰁯󰁷 󰁷󰁨󰁥󰁲󰁥 󰁷󰁥 󰁩󰁮󰁪󰁥󰁣󰁴 󰁴󰁨󰁥 󰁦󰁬󰁵󰁩󰁤 󰁯󰁲 󰁢󰁬󰁯󰁯󰁤 󰁴󰁨󰁥󰁲󰁥 󰁴󰁨󰁥󰁮 󰁩󰁴 󰁧󰁯󰁥󰁳 󰁴󰁯 󰁴󰁨󰁥 󰁳󰁹󰁳󰁴󰁥󰁭 󰁩󰁭󰁭󰁥󰁤󰁩󰁡󰁴󰁥󰁬󰁹).   A󰁧󰁥 󰁬󰁩󰁭󰁩󰁴?   L󰁡󰁮󰁤󰁭󰁡󰁲󰁫󰁳? F󰁬󰁵󰁩󰁤󰁳: 󰁣󰁲󰁹󰁳󰁴󰁡󰁬󰁬󰁯󰁩󰁤 (󰁮󰁯󰁲󰁭󰁡󰁬 󰁳󰁡󰁬󰁩󰁮󰁥 󰁢󰁥󰁣󰁡󰁵󰁳󰁥 󰁩󰁳󰁯󰁴󰁯󰁮󰁩󰁣) 20󰁣󰁣/󰁫󰁧 󰁸 2, 󰁴󰁨󰁥󰁮 10󰁣󰁣/󰁫󰁧 󰁰RBC . ♣ ♣   󰁮󰁯 󰁲󰁯󰁬󰁥 󰁦󰁯󰁲 MAST: ↑ 󰁭󰁯󰁲󰁴󰁡󰁬󰁩󰁴󰁹.

*󰁎󰁏󰁔󰁅󰁓󰀺

󰀭󰁮󰁯󰁲󰁭󰁡󰁬 󰁳󰁡󰁬󰁩󰁮󰁥󰀺 󰁎󰁡󰁃󰁬 (󰁎󰁡 154 󰁭.󰁭󰁯󰁬, 󰁃󰁬  154 󰁭.󰁭󰁯󰁬). 󰀭 󰁔󰁯󰁴󰁡󰁬 󰁢󰁬󰁯󰁯󰁤 󰁶󰁯󰁬󰁵󰁭󰁥󰀺 󰀭󰁡󰁤󰁵󰁬󰁴󰁳 5 󰁌. 󰀭󰁃󰁨󰁩󰁬󰁤󰁲󰁥󰁮  󰀸0 󰀭120 󰁣󰁣/󰁫󰁧.

󰁥   󰀸󰁼󰁐󰁡󰁧󰁥

 

Pediatric Trauma (Not Just Small Adults)

S󰁕RG GP. 425

Monday, Oct 29 2007

󰁄󰁲. 󰁁󰁡󰁹󰁥󰁤 󰁁󰁬󰀭󰁑 󰁡󰁨󰁴󰁡󰁮󰁩 󰁡󰁨󰁴󰁡󰁮󰁩  

󰁁󰁳󰁳. 󰁐󰁲󰁯󰁦󰁥󰁳󰁳󰁯󰁲 & 󰁃󰁯󰁮󰁳󰁵󰁬󰁴󰁡󰁮󰁴 󰁰󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣 󰁳󰁵󰁲󰁧󰁥󰁲󰁹

F󰁩󰁧󰁵󰁲󰁥: 󰁩󰁮󰁴󰁲󰁡󰁯󰁳󰁳󰁥󰁯󰁵󰁳 

Secondar y  ssur vey  ::   B󰁥󰁧󰁩󰁮󰁳 󰁯󰁮󰁣󰁥 󰁴󰁨󰁥 󰁰󰁲󰁩󰁭󰁡󰁲󰁹 󰁳󰁵󰁲󰁶󰁥󰁹 (ABC󲀙󰁳) 󰁩󰁳 󰁣󰁯󰁭󰁰󰁬󰁥󰁴󰁥󰁤, 󰁲󰁥󰁳󰁵󰁳󰁣󰁩󰁴󰁡󰁴󰁩󰁯󰁮 󰁨󰁡󰁳 󰁣󰁯󰁭󰁭󰁥󰁮󰁣󰁥󰁤 󰁡󰁮󰁤 󰁴󰁨󰁥 󰁰󰁡󰁴󰁩󰁥󰁮󰁴󲀙󰁳 ♣ B󰁥󰁧󰁩󰁮󰁳 ABC󲀙󰁳 󰁨󰁡󰁶󰁥 󰁢󰁥󰁥󰁮 󰁲󰁥󰁡󰁳󰁳󰁥󰁳󰁳󰁥󰁤.  󰁘󰀭󰁲󰁡󰁹󰁳 󰁘󰀭󰁲󰁡󰁹󰁳 󰁡󰁲󰁥 󰁢󰁥󰁦󰁯󰁲󰁥 2󰁮󰁤 󰁳󰁵󰁲󰁶󰁥󰁹, 󰁪󰁵󰁳󰁴 󰁡󰁦󰁴󰁥󰁲 󰁰󰁲󰁩󰁭󰁡󰁲󰁹. ♣ A 󰁨󰁥󰁡󰁤󰀭󰁴󰁯󰀭󰁴󰁯󰁥 󰁥󰁶󰁡󰁬󰁵󰁡󰁴󰁩󰁯󰁮 󰁩󰁮󰁣󰁬󰁵󰁤󰁩󰁮󰁧:  󰁖󰁩󰁴󰁡󰁬 󰁖󰁩󰁴󰁡󰁬 󰁳󰁩󰁧󰁮󰁳, 󰁡󰁮󰁤 󰁣󰁯󰁭󰁰󰁬󰁥󰁴󰁥 󰁨󰁩󰁳󰁴󰁯󰁲󰁹 󰁡󰁮󰁤 󰁰󰁨󰁹󰁳󰁩󰁣󰁡󰁬 󰁥󰁸󰁡󰁭󰁩󰁮󰁡󰁴󰁩󰁯󰁮.  AMPLE: AMPLE:  󰁁   󰀽 󰁁󰁬󰁬󰁥󰁲󰁧󰁩󰁥󰁳.  󰁍 󰀽 󰁍󰁥󰁤󰁩󰁣󰁡󰁴󰁩󰁯󰁮󰁳.  

󰁐󰁡󰁳󰁴󰁭󰁥󰁡󰁬 󰁩󰁬󰁬󰁮󰁥󰁳󰁳󰁥󰁳.  󰁐 󰁌 󰀽󰀽 󰁌󰁡󰁳󰁴 󰁴󰁩󰁭󰁥.

 󰁅 󰀽 󰁅󰁶󰁥󰁮󰁴󰁳/ 󰁅󰁮󰁶󰁩󰁲󰁯󰁮󰁭󰁥󰁮󰁴 󰁲󰁥󰁬󰁡󰁴󰁥󰁤 󰁴󰁯 󰁴󰁨󰁥 󰁩󰁮󰁪󰁵󰁲󰁹 .

Head  iin jur y:   ♣  󰁬󰁥󰁡󰁤󰁩󰁮󰁧 󰁣󰁡󰁵󰁳󰁥 󰁯󰁦 󰁤󰁥󰁡󰁴󰁨 󰁩󰁮 󰁰󰁥󰁤󰁳 󰁴󰁲󰁡󰁵󰁭󰁡 (80%) . ♣  90 % 󲀜󰁭󰁩󰁮󰁯󰁲󲀝. ♣  F󰁡󰁬󰁬󰁳 > M󰁖A > MPA > 󰁢󰁩󰁣󰁹󰁣󰁬󰁥 > 󰁡󰁳󰁳󰁡󰁵󰁬󰁴. ♣  F󰁥󰁷 󰁲󰁥󰁱󰁵󰁩󰁲󰁥 󰁳󰁵󰁲󰁧󰁥󰁲󰁹: 0.4 󰀭1.5%. ♣  N󰁯 󰁥󰁶󰁩󰁤󰁥󰁮󰁣󰁥 󰁩󰁮 󰁰󰁥󰁤󰁳 󰁦󰁯󰁲 󰁥󰁡󰁲󰁬󰁹 󰁳󰁵󰁲󰁧󰁥󰁲󰁹. ♣  4󰀭6% 󰁷󰁩󰁴󰁨 󰁮󰁯󰁲󰁭󰁡󰁬 󰁥󰁸󰁡󰁭 󰁨󰁡󰁶󰁥 ICH 󰁯󰁮 CT   ?󰁳󰁩󰁧󰁮󰁩󰁦󰁩󰁣󰁡󰁮󰁣󰁥   ?󰁬󰁯󰁮󰁧 󰁴󰁥󰁲󰁭 󰁳󰁥󰁱󰁵󰁥󰁬. Head  iin j ju ur y:  A Anatomic  d differ ences:   Protective

♣  F󰁯󰁮󰁴󰁡󰁮󰁥󰁬󰁬󰁥󰁳 . ♣  󰁯󰁰󰁥󰁮 󰁳󰁵󰁴󰁵󰁲󰁥󰁳 . ♣  󰁰󰁬󰁡󰁳󰁴󰁩󰁣󰁩󰁴󰁹 .

󰁨󰁥󰁬󰁰󰁳 󰁩󰁮 󰁥󰁸󰁰󰁡󰁮󰁤󰁩󰁮󰁧 󰁴󰁨󰁥 󰁳󰁫󰁵󰁬󰁬.

󰁥   󰀹󰁼󰁐󰁡󰁧󰁥

 

Pediatric Trauma (Not Just Small Adults)

S󰁕RG GP. 425

Monday, Oct 29 2007

󰁄󰁲. 󰁁󰁡󰁹󰁥󰁤 󰁁󰁬󰀭󰁑 󰁡󰁨󰁴󰁡󰁮󰁩 󰁡󰁨󰁴󰁡󰁮󰁩  

󰁁󰁳󰁳. 󰁐󰁲󰁯󰁦󰁥󰁳󰁳󰁯󰁲 & 󰁃󰁯󰁮󰁳󰁵󰁬󰁴󰁡󰁮󰁴 󰁰󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣 󰁳󰁵󰁲󰁧󰁥󰁲󰁹

Susceptible

♣  󰁢󰁩󰁧 󰁨󰁥󰁡󰁤 → 󰁴󰁯󰁲󰁱󰁵󰁥 . ♣  󰁳󰁯󰁦󰁴 󰁣󰁲󰁡󰁮󰁩󰁵󰁭 →  󰁩󰁮󰁪󰁵󰁲󰁹 󰁷󰁩󰁴󰁨󰁯󰁵󰁴 󰁷󰁩󰁴󰁨󰁯󰁵󰁴 󰁦󰁲󰁡󰁣󰁴󰁵󰁲󰁥 . ♣  󰁬󰁥󰁳󰁳 󰁭󰁹󰁥󰁬󰁩󰁮 →  󰁭󰁯󰁲󰁥 󰁳󰁨󰁥󰁡󰁲󰁩󰁮󰁧 󰁦󰁯󰁲󰁣󰁥󰁳 . ♣  󰁰󰁲󰁯󰁮󰁥 󰁴󰁯 󰁲󰁥󰁡󰁣󰁴󰁩󰁶󰁥 󰁨󰁹󰁰󰁥󰁲󰁥󰁭󰁩󰁡 .

Head  iin j ju ur y:  TTypes  o of  iin j ju ur y:  ((doctor  d mention  tthis)    didn’t m ♣  C󰁯󰁮󰁴󰁵󰁳󰁩󰁯󰁮󰁳, DAI, SAH, 󰁰󰁡󰁲󰁥󰁮󰁣󰁨󰁹󰁭󰁡󰁬. ♣  E󰁰󰁩󰁤󰁵󰁲󰁡󰁬: 󰁵󰁮󰁣󰁯󰁭󰁭󰁯󰁮, <4 󰁹󰁥󰁡󰁲󰁳, 󰁳󰁵󰁢󰁴󰁬󰁥 󰁰󰁲󰁥󰁳󰁥󰁮󰁴󰁡󰁴󰁩󰁯󰁮, 󰁭󰁩󰁮󰁯󰁲 󰁴󰁲󰁡󰁵󰁭󰁡. ♣  S󰁵󰁢󰁤󰁵󰁲󰁡󰁬: 󰁣󰁯󰁭󰁭󰁯󰁮, 󰁰󰁯󰁯󰁲 󰁯󰁵󰁴󰁣󰁯󰁭󰁥, <1 󰁹󰁥󰁡󰁲.   SBS: 󰁶󰁯󰁭󰁩󰁴, FTT, LOC, 󰁳󰁥󰁩󰁺󰁵󰁲󰁥, 󰁲󰁥󰁴󰁩󰁮󰁡󰁬 󰁨󰁥󰁭󰁯󰁲󰁲󰁨󰁡󰁧󰁥󰁳. Head  iin j ju ur y:  A Assessment:  ((doctor  d mention  tthis)    didn’t m ♣  P󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣 GCS: 󰁮󰁯󰁴 󰁰󰁲󰁥󰁤󰁩󰁣󰁴󰁩󰁶󰁥 󰁩󰁮 󰁩󰁮󰁦󰁡󰁮󰁴󰁳. ♣  S󰁩󰁧󰁮󰁳 󰁯󰁦 ↑ ICP 󰁩󰁮 󰁩󰁮󰁦󰁡󰁮󰁴󰁳:   F󰁵󰁬󰁬 󰁦󰁯󰁮󰁴󰁡󰁮󰁥󰁬󰁬󰁥, 󰁳󰁰󰁬󰁩󰁴 󰁳󰁵󰁴󰁵󰁲󰁥󰁳, 󰁡󰁬󰁴. LOC, 󰁩󰁲󰁲󰁩󰁴󰁡󰁢󰁬󰁥, 󰁰󰁥󰁲󰁳󰁩󰁳󰁴󰁥󰁮󰁴 󰁥󰁭󰁥󰁳󰁩󰁳, 󲀜󰁳󰁥󰁴󰁴󰁩󰁮󰁧 󰁳󰁵󰁮󲀝 󰁳󰁩󰁧󰁮 . Sk ull  ffr actur e:  ((doctor  d mention  tthis)    didn’t m ♣  20 󰁸 ↑ 󰁲󰁩󰁳󰁫 ICH ♣  ♣  ♣  ♣  ♣ 

 

50% 󰁯󰁦 󰁰󰁡󰁲󰁩󰁥󰁴󰁡󰁬 󰁢󰁯󰁮󰁥, 75% 󰁯󰁦 󰁯󰁣󰁣󰁩󰁰󰁩󰁴󰁡󰁬 󰁢󰁯󰁮󰁥. L󰁩󰁮󰁥󰁡󰁲 > 󰁤󰁥󰁰󰁲󰁥󰁳󰁳󰁥󰁤 > 󰁢󰁡󰁳󰁩󰁬󰁡󰁲. 󰁘󰀭󰁲󰁡󰁹󰁳 󰁮󰁥󰁩󰁴󰁨󰁥󰁲 󰁳󰁥󰁮󰁳󰁩󰁴󰁩󰁶󰁥 󰁮󰁯󰁲 󰁳󰁰󰁥󰁣󰁩󰁦󰁩󰁣. 90% 󰁬󰁩󰁮󰁥󰁡󰁲 󰁢󰁯󰁮󰁥󰁳 󰁨󰁡󰁶󰁥 󰁯󰁶󰁥󰁲󰁬󰁹󰁩󰁮󰁧 󰁨󰁥󰁭󰁡󰁴󰁯󰁭󰁡. 󲀜G󰁲󰁯󰁷󰁩󰁮󰁧 󰁳󰁫󰁵󰁬󰁬 󰁢󰁯󰁮󰁥󲀝:󰁤󰁩󰁡󰁳󰁴󰁡󰁴󰁩󰁣 → 󰁤󰁵󰁲󰁡󰁬 󰁴󰁥󰁡󰁲 → 󰁭󰁥󰁮󰁩󰁮󰁧󰁥󰁳 󰁨󰁥󰁲󰁮󰁩󰁡󰁴󰁥, 󰁰󰁲󰁥󰁶󰁥󰁮󰁴󰁳 󰁣󰁬󰁯󰁳󰁵󰁲󰁥: NS󰁸 F/󰁕 . 󰁤󰁥󰁰󰁲󰁥󰁳󰁳󰁥󰁤 󰁢󰁯󰁮󰁥: 󰁭󰁡󰁹 󰁭󰁩󰁳󰁳 󰁯󰁮 CT .

Interpretation?

10 󰁼 󰁐 󰁡 󰁧 󰁥  󰁥 

 

Pediatric Trauma (Not Just Small Adults)

S󰁕RG GP. 425

Monday, Oct 29 2007

󰁄󰁲. 󰁁󰁡󰁹󰁥󰁤 󰁁󰁬󰀭󰁑 󰁡󰁨󰁴󰁡󰁮󰁩 󰁡󰁨󰁴󰁡󰁮󰁩  

󰁁󰁳󰁳. 󰁐󰁲󰁯󰁦󰁥󰁳󰁳󰁯󰁲 & 󰁃󰁯󰁮󰁳󰁵󰁬󰁴󰁡󰁮󰁴 󰁰󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣 󰁳󰁵󰁲󰁧󰁥󰁲󰁹

Growing S Sk ull  F Fracture  

󰁑󰁵󰁡󰁹󰁬󰁥 󰁥󰁴 󰁡󰁬. 󰁊 󰁎󰁥󰁵󰁲󰁯󰁳󰁵󰁲󰁧. 1990  

♣  󰁡󰁬󰁴 LOC, 󰁦󰁯󰁣󰁡󰁬 󰁤󰁥󰁦󰁩󰁣󰁩󰁴, 󰁰󰁡󰁬󰁰󰁡󰁢󰁬󰁥 󰁤󰁥󰁰󰁲󰁥󰁳󰁳󰁩󰁯󰁮, 󰁢󰁡󰁳󰁡󰁬 󰁳󰁫󰁵󰁬󰁬 #, 󰁳󰁥󰁩󰁺󰁵󰁲󰁥 . ♣  󰁡󰁬󰁬 HI < 1 󰁹󰁥󰁡󰁲 .

11 󰁼 󰁐 󰁡 󰁧 󰁥  󰁥 

 

Pediatric Trauma (Not Just Small Adults)

S󰁕RG GP. 425

Monday, Oct 29 2007

󰁄󰁲. 󰁁󰁡󰁹󰁥󰁤 󰁁󰁬󰀭󰁑 󰁡󰁨󰁴󰁡󰁮󰁩 󰁡󰁨󰁴󰁡󰁮󰁩  

󰁁󰁳󰁳. 󰁐󰁲󰁯󰁦󰁥󰁳󰁳󰁯󰁲 & 󰁃󰁯󰁮󰁳󰁵󰁬󰁴󰁡󰁮󰁴 󰁰󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣 󰁳󰁵󰁲󰁧󰁥󰁲󰁹

Who  g gets  C CT?   ♣  C󰁨󰁩󰁬󰁤󰁲󰁥󰁮 < 2 󰁹󰁥󰁡󰁲󰁳 .    

󰁨󰁡󰁲󰁤 󰁴󰁯 󰁡󰁳󰁳󰁥󰁳󰁳 . 󰁰󰁲󰁯󰁮󰁥 󰁴󰁯 ICH, 󰁳󰁫󰁵󰁬󰁬 󰁢󰁯󰁮󰁥 .   󰁡󰁳󰁹󰁭󰁰󰁴󰁯󰁭󰁡󰁴󰁩󰁣 ICH (4󰀭19%) .   󰁬󰁯󰁷 󰁴󰁨󰁲󰁥󰁳󰁨󰁯󰁬󰁤 . ♣  󰁶󰁡󰁲󰁩󰁯󰁵󰁳 󰁡󰁬󰁧󰁯󰁲󰁩󰁴󰁨󰁭󰁳, 󰁮󰁯 󰁣󰁯󰁮󰁳󰁥󰁮󰁳󰁵󰁳.

CT  h head  a algor ithms  :: 󰁓󰁡󰁶󰁩󰁴󰁳󰁫󰁹, 󰁁󰁭 󰁊 󰁅󰁭󰁥󰁲󰁧 󰁍󰁥󰁤. 2000  

Pr edictor s  o of  IICH  ::  

♣  Greene, Pediatrics 1999   Scalp hematoma most sensitive clinical predictor  

󰁑󰁵󰁡󰁹󰁬󰁥, 󰁐󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣󰁳 1997   ♣  󰁑󰁵󰁡󰁹󰁬󰁥,    󰁤󰁥󰁰󰁲󰁥󰁳󰁳󰁥󰁤 LOC (OR=4), 󰁦󰁯󰁣󰁡󰁬 󰁮󰁥󰁵󰁲󰁯 (OR=8), 󰁳󰁫󰁵󰁬󰁬 󰁢󰁯󰁮󰁥, LOC > 5 󰁭󰁩󰁮, 󰁳󰁥󰁩󰁺󰁵󰁲󰁥 (󰁴󰁲󰁥󰁮󰁤) . ♣  󰁂󰁥󰁮󰁩󰀭󰁁󰁤󰁡󰁮󰁩, 󰁊 󰁔󰁲󰁡󰁵󰁭󰁡 1999   TINS 󰁳󰁣󰁯󰁲󰁥 󰁦󰁯󰁲 EDH; 󰁮󰁯󰁴 󰁶󰁡󰁬󰁩󰁤󰁡󰁴󰁥󰁤 .  . 

12 󰁼 󰁐 󰁡 󰁧 󰁥  󰁥 

 

Pediatric Trauma

S󰁕RG GP. 425

(Not Just Small Adults) Monday, Oct 29 2007

󰁄󰁲. 󰁁󰁡󰁹󰁥󰁤 󰁁󰁬󰀭󰁑 󰁡󰁨󰁴󰁡󰁮󰁩 󰁡󰁨󰁴󰁡󰁮󰁩  

󰁁󰁳󰁳. 󰁐󰁲󰁯󰁦󰁥󰁳󰁳󰁯󰁲 & 󰁃󰁯󰁮󰁳󰁵󰁬󰁴󰁡󰁮󰁴 󰁰󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣 󰁳󰁵󰁲󰁧󰁥󰁲󰁹

AAP Guidelines: Guidelines:

Management:   (the  main   pr inciple  is   to   maintain   br ain   blood   supply  and   decr ease  intr a  c cr anial  p pr essur e)   ♣  MAP > 70 󰁴󰁥󰁥󰁮, 60 󰁣󰁨󰁩󰁬󰁤, 45 󰁩󰁮󰁦󰁡󰁮󰁴 . ♣  󰁨󰁹󰁰󰁥󰁲󰁶󰁥󰁮󰁴󰁩󰁬󰁡󰁴󰁩󰁯󰁮: 󰁮󰁯󰁴 󰁩󰁮 1󰁳󰁴 24 󰁨󰁲 . ♣  󰁭󰁡󰁮󰁮󰁩󰁴󰁯󰁬: 󰁮󰁯 󰁳󰁴󰁵󰁤󰁩󰁥󰁳 . ♣  HTS: 󰁳󰁭󰁡󰁬󰁬 󰁳󰁴󰁵󰁤󰁩󰁥󰁳 . ♣  E󰁵󰁧󰁬󰁹󰁣󰁥󰁭󰁩󰁡: ↑󰁧󰁬󰁵󰁣󰁯󰁳󰁥 󰁷󰁯󰁲󰁳󰁥 󰁮󰁥󰁵󰁲󰁯 󰁯󰁵󰁴󰁣󰁯󰁭󰁥 . ♣  󰁰󰁲󰁯󰁰󰁨󰁹󰁬󰁡󰁣󰁴󰁩󰁣 󰁡󰁮󰁴󰁩󰁣󰁯󰁮󰁶󰁵󰁬󰁳󰁡󰁮󰁴󰁳: 󰁣󰁯󰁮󰁳󰁩󰁤󰁥󰁲 󰁩󰁮 󰁭󰁯󰁤󰁥󰁲󰁡󰁴󰁥/󰁳󰁥󰁶󰁥󰁲󰁥 HI, >1 󰁳󰁥󰁩󰁺󰁵󰁲󰁥 󰁯󰁲 󰁰󰁲󰁯󰁬󰁯󰁮󰁧󰁥󰁤 . ♣  󰁰󰁲󰁯󰁰󰁨󰁹󰁬󰁡󰁣󰁴󰁩󰁣 A󰁢󰁸 󰁦󰁯󰁲 󰁢󰁡󰁳󰁩󰁬 󰁳󰁫󰁵󰁬󰁬 󰁢󰁯󰁮󰁥 : 󰁮󰁯 󰁲󰁯󰁬󰁥 . ♣  N󰁯󰁲󰁭󰁯󰁴󰁨󰁥󰁲󰁭󰁩󰁡: 󰁴󰁥󰁭󰁰 > 38.5 󰁷󰁯󰁲󰁳󰁥 󰁮󰁥󰁵󰁲󰁯 󰁯󰁵󰁴󰁣󰁯󰁭󰁥 . Hyper tonic S Saline  ::  󰁓󰁩󰁭󰁭󰁡 󰁥󰁴 󰁡󰁬. 󰁃󰁲󰁩󰁴 󰁃󰁡󰁲󰁥 󰁍󰁥󰁤 1998   ♣ 󰁓󰁩󰁭󰁭󰁡  󰁰󰁲󰁯󰁳󰁰󰁥󰁣󰁴󰁩󰁶󰁥 󰁰󰁲󰁯󰁳󰁰󰁥󰁣󰁴󰁩󰁶󰁥 RCT, 35 TBI 󰁫󰁩󰁤󰁳  RL RL 󰁶󰁳. HTS  󰁦󰁥󰁷󰁥󰁲 󰁦󰁥󰁷󰁥󰁲 󰁩󰁮󰁴󰁥󰁲󰁶󰁥󰁮󰁴󰁩󰁯󰁮󰁳 󰁴󰁯 󰁫󰁥󰁥󰁰 ICP<15 HTS 󰁧󰁲󰁯󰁵󰁰.  󰁳󰁨󰁯󰁲󰁴󰁥󰁲 󰁳󰁨󰁯󰁲󰁴󰁥󰁲 IC󰁕 󰁳󰁴󰁡󰁹 󰁷󰁩󰁴󰁨 HTS (3 󰁤󰁡󰁹󰁳) .  󰁳󰁡󰁭󰁥 󰁳󰁡󰁭󰁥 󰁳󰁵󰁲󰁶󰁩󰁶󰁡󰁬 󰁳󰁵󰁲󰁶󰁩󰁶󰁡󰁬 󰁡󰁮󰁤 󰁴󰁯󰁴󰁡󰁬 󰁨󰁯󰁳 󰁩󰁴󰁡󰁬 󰁳󰁴󰁡 .

󰁥󰁴  󰁡 󰁐 󰁥󰁤 󰁩 󰁩󰁡 20 0  ♣  󰁋  󰁋󰁨   󰁡󰁮󰁮󰁡  󰁥  󰁡󰁬 .  󰁐    󰁴 󰁲  󰁲󰁩 󰁩 󰁣   󰁣󰁳   2 00   0     10  󰁫 󰁫󰁩󰁤󰁳  󰁷 󰁷󰁩󰁴󰁨  T TBI,  󰁲󰁲󰁥󰁳󰁩󰁳󰁴󰁡󰁮󰁴  󰁴󰁴󰁯   󰁣󰁯󰁮󰁶󰁥󰁮󰁴󰁩󰁯󰁮󰁡󰁬  R R󰁸      󰁳󰁴󰁡󰁴󰁩󰁳󰁴󰁩󰁣󰁡󰁬󰁬󰁹  󰁳 󰁳󰁩󰁧󰁮  ↓ICP  󰁷 󰁷󰁩󰁴󰁨  H HTS  ..  

C-Spine  IIn jur ies  ::  ♣  L󰁥󰁳󰁳 󰁣󰁯󰁭󰁭󰁯󰁮 󰁩󰁮 󰁫󰁩󰁤󰁳, 󰁨󰁩󰁧󰁨󰁥󰁲 󰁭󰁯󰁲󰁴󰁡󰁬󰁩󰁴󰁹 . ♣  A󰁳󰁳󰁯󰁣󰁩󰁡󰁴󰁥󰁤 󰁷󰁩󰁴󰁨 H󰁥󰁡󰁤 I󰁮󰁪󰁵󰁲󰁹. ♣  󰁦󰁡󰁬󰁬󰁳>M󰁖A>󰁳󰁰󰁯󰁲󰁴󰁳 (󰁴󰁲󰁡󰁭󰁰󰁯󰁬󰁩󰁮󰁥󰁳). ♣  <8 󰁹󰁥󰁡󰁲󰁳: 2/3 󰁡󰁢󰁯󰁶󰁥 C3 .

13 󰁼 󰁐 󰁡 󰁧 󰁥  󰁥 

 

Pediatric Trauma (Not Just Small Adults)

S󰁕RG GP. 425

Monday, Oct 29 2007

󰁄󰁲. 󰁁󰁡󰁹󰁥󰁤 󰁁󰁬󰀭󰁑 󰁡󰁨󰁴󰁡󰁮󰁩 󰁡󰁨󰁴󰁡󰁮󰁩  

󰁁󰁳󰁳. 󰁐󰁲󰁯󰁦󰁥󰁳󰁳󰁯󰁲 & 󰁃󰁯󰁮󰁳󰁵󰁬󰁴󰁡󰁮󰁴 󰁰󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣 󰁳󰁵󰁲󰁧󰁥󰁲󰁹

C-Spine:  A Anatomic d differ ences  ::   ♣  󰁢󰁩󰁧 󰁨󰁥󰁡󰁤, 󰁬󰁥󰁳󰁳 󰁭󰁵󰁳󰁣󰁬󰁥󰁳 → 󰁴󰁯󰁲󰁱󰁵󰁥, 󰁦󰁵󰁬󰁣󰁲󰁵󰁭 C2󰀭3 . ♣  󰁣󰁡󰁲󰁴󰁩󰁬󰁡󰁧󰁥 > 󰁢󰁯󰁮󰁥, 󰁬󰁡󰁸 󰁬󰁩󰁧󰁡󰁭󰁥󰁮󰁴󰁳 󰁩󰁮󰁪󰁵󰁲󰁹 󰁷󰁩󰁴󰁨󰁯󰁵󰁴 󰁢󰁯󰁮󰁥. ♣  󰁰󰁳󰁥󰁵󰁤󰁯󰁳󰁵󰁢󰁬󰁵󰁸󰁡󰁴󰁩󰁯󰁮  C2󰀭3, C2󰀭3, C3󰀭4: 3󰀭4 󰁭󰁭 󰁯󰁲 50% 󰁶󰁥󰁲󰁴󰁥󰁢󰁲󰁡󰁬 󰁢󰁯󰁤󰁹 󰁷󰁩󰁤󰁴󰁨 .  󰁵󰁳󰁥 󰁵󰁳󰁥 󰁓󰁷󰁩󰁳󰁣󰁨󰁵󰁫󲀙󰁳 󰁓󰁷󰁩󰁳󰁣󰁨󰁵󰁫󲀙󰁳 󰁬󰁩󰁮󰁥  󰁬󰁩󰁮󰁥 . ♣  󰁰󰁲󰁥󰁶󰁥󰁲󰁴󰁥󰁢󰁲󰁡󰁬 󰁳󰁰󰁡󰁣󰁥: C2=7󰁭󰁭, C3=5, C7=2󰁣󰁭 . ♣  󰁦󰁡󰁣󰁥󰁴󰁳 󰁪󰁯󰁩󰁮󰁴󰁳 󰁨󰁯󰁲󰁩󰁺󰁯󰁮󰁴󰁡󰁬, 󰁡󰁮󰁴󰁥󰁲󰁩󰁯󰁲 󰁷󰁥󰁤󰁧󰁩󰁮󰁧 󰁶󰁥󰁲󰁴󰁥󰁢󰁲󰁡󰁬 󰁢󰁯󰁤󰁩󰁥󰁳 . ♣  󰁰󰁲󰁥󰁤󰁥󰁮󰁴󰁡󰁬 󰁳󰁰󰁡󰁣󰁥 4󰀭5 󰁭󰁭 . ♣  󰁩󰁮󰁣󰁯󰁭󰁰󰁬󰁥󰁴󰁥 󰁯󰁳󰁳󰁩󰁦󰁩󰁣󰁡󰁴󰁩󰁯󰁮, 󰁭󰁵󰁬󰁴󰁩󰁰󰁬󰁥 󰁣󰁥󰁮󰁴󰁥󰁲󰁳 .

C-Spine  IImaging ::  ♣  3󰀭󰁶󰁩󰁥󰁷󰁳 : AP, L󰁡󰁴󰁥󰁲󰁡󰁬, O󰁰󰁥󰁮 󰁭󰁯󰁵󰁴󰁨 .   94% 󰁳󰁥󰁮󰁳󰁩󰁴󰁩󰁶󰁥 󰀭 󰁢󰁵󰁴 SCI󰁗ORA ♣  󰁆󰁬󰁥󰁸󰁩󰁯󰁮󰀭󰁥󰁸󰁴󰁥󰁮󰁳󰁩󰁯󰁮󰀿  󰁒󰁡󰁬󰁳󰁴󰁯󰁮 󰁒󰁡󰁬󰁳󰁴󰁯󰁮 󰁁󰁣󰁡󰁤 󰁅󰁭󰁥󰁲󰁧 󰁍󰁥󰁤 2001  

󰁮󰁯 󰁡󰁤󰁤󰁥󰁤 󰁩󰁮󰁦󰁯 󰁩󰁦 3 󰁶󰁩󰁥󰁷󰁳 󰁮󰁯󰁲󰁭󰁡󰁬 .

SCIWORA  :  ((=  S Spinal  C Cord IIn jury  W WithOut  R Radiological  A Abnormalities)   󰀭N󰁯󰁲󰁭󰁡󰁬 󰁘󰀭󰁲󰁡󰁹 󰁩󰁮 󰁭󰁡󰁪󰁯󰁲 󰁩󰁮󰁪󰁵󰁲󰁹 󰁥.󰁧. 󰁩󰁮 󰁤󰁥󰁳󰁴󰁲󰁵󰁣󰁴󰁩󰁯󰁮 󰁯󰁦 󰁬󰁩󰁧󰁡󰁭󰁥󰁮󰁴󰁳 󰁡󰁮󰁤 󰁴󰁥󰁮󰁤󰁯󰁮󰁳 󰁷󰁩󰁴󰁨 󰁮󰁯󰁲󰁭󰁡󰁬 󰁸󰀭󰁲󰁡󰁹.

♣  ♣  ♣  ♣  ♣ 

16󰀭50% SCI!! < 9 󰁹󰁥󰁡󰁲󰁳 . 󰁴󰁲󰁡󰁮󰁳󰁩󰁥󰁮󰁴 󰁮󰁥󰁵󰁲󰁯 󰁳󰁹󰁭󰁰󰁴󰁯󰁭󰁳 (󰁰󰁡󰁲󰁡󰁳󰁴󰁨󰁥󰁳󰁩󰁡󰁳) . 󰁲󰁥󰁣󰁵󰁲 󰁵󰁰 󰁴󰁯 4 󰁤󰁡󰁹󰁳 󰁬󰁡󰁴󰁥󰁲 . 󰁢󰁯󰁴󰁴󰁯󰁭 󰁬󰁩󰁮󰁥:   CT/MRI 󰁩󰁦 󰁡󰁢󰁮 󰁮󰁥󰁣󰁫/󰁮󰁥󰁵󰁲󰁯 󰁥󰁸󰁡󰁭, 󰁤󰁩󰁳󰁴󰁲󰁡󰁣󰁴󰁩󰁮󰁧 󰁩󰁮󰁪󰁵󰁲󰁩󰁥󰁳, 󰁡󰁬󰁴. LOC, 󰁨󰁩󰁧󰁨 󰁲󰁩󰁳󰁫 󰁭󰁥󰁣󰁨 DESPITE 󰁮󰁯󰁲󰁭󰁡󰁬 3󰀭 󰁶󰁩󰁥󰁷󰁳.

Case : ♣  6󰀭 󰁹󰁥󰁡󰁲󰀭󰁯󰁬󰁤 󰁧󰁩󰁲󰁬 󰁦󰁥󰁬󰁬 󰁯󰁦󰁦 󰁢󰁩󰁫󰁥 ♣  󰁗󰁨󰁡󰁴󲀙󰁳 󰁴󰁨󰁥 󰁡󰁢󰁮󰁯󰁲󰁭󰁡󰁬󰁩󰁴󰁹?

14 󰁼 󰁐 󰁡 󰁧 󰁥  󰁥 

 

Pediatric Trauma (Not Just Small Adults)

S󰁕RG GP. 425

Monday, Oct 29 2007

󰁄󰁲. 󰁁󰁡󰁹󰁥󰁤 󰁁󰁬󰀭󰁑 󰁡󰁨󰁴󰁡󰁮󰁩 󰁡󰁨󰁴󰁡󰁮󰁩  

󰁁󰁳󰁳. 󰁐󰁲󰁯󰁦󰁥󰁳󰁳󰁯󰁲 & 󰁃󰁯󰁮󰁳󰁵󰁬󰁴󰁡󰁮󰁴 󰁰󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣 󰁳󰁵󰁲󰁧󰁥󰁲󰁹

Endotr acheal  iintubaton  :     ETT 󰁳󰁩󰁺󰁥? 󰀭 󰁂󰁲󰁯󰁳󰁥󰁬󰁯󰁷   󰀭 A󰁧󰁥 (󰁹󰁥󰁡󰁲󰁳) + 4 4   󰁣󰁵󰁦󰁦󰁥󰁤?

󰀭 󰁕󰁮󰁣󰁵󰁦󰁦󰁥󰁤 < 8 󰁹󰁥󰁡󰁲󰁳 󰁯󰁬󰁤 (󰁥󰁸󰁣󰁥󰁰󰁴󰁩󰁯󰁮󰁳)

  󰁤󰁥󰁰󰁴󰁨 󰁯󰁦 󰁩󰁮󰁳󰁥󰁲󰁴󰁩󰁯󰁮?

󰀭 D󰁥󰁰󰁴󰁨 󰁯󰁦 󰁩󰁮󰁳󰁥󰁲󰁴󰁩󰁯󰁮 (󰁣󰁭): 󰁴󰁵󰁢󰁥 ID (󰁭󰁭) 󰁸 3 󰁯󰁲 󰁡󰁧󰁥 (󰁹󰁥󰁡󰁲󰁳)/2 + 12

Failed  iintubation  ::   ♣  BM󰁖 󰁷󰁩󰁴󰁨 S󰁥󰁬󰁬󰁩󰁣󰁫 ♣  LMA 󰁡󰁮 󰁯󰁰󰁴󰁩󰁯󰁮 ♣  N󰁯 󰁣󰁲󰁩󰁣󰁯󰁴󰁨󰁹󰁲󰁯󰁩󰁤󰁯󰁴󰁯󰁭󰁹 󰁵󰁮󰁤󰁥󰁲 8 󰁹󰁥󰁡󰁲󰁳 ♣  I󰁮 󰁡 󰁰󰁩󰁮󰁣󰁨: N󰁥󰁥󰁤󰁬󰁥 󰁣󰁲󰁩󰁣 . Ped♣ia r ic ttr a uma(󰁳󰁵󰁧󰁡󰁲)  ::     t󰁕󰁳󰁵󰁡󰁬 ABC󲀙󰁳 󰁡󰁮󰁤 C󰀭󰁳󰁰󰁩󰁮󰁥 ♣  󰁕󰁳󰁥 󰁹󰁯󰁵󰁲 B󰁲󰁯󰁳󰁥󰁬󰁯󰁷 ♣  󰁗󰁥󰁩󰁧󰁨󰁴 󰁣󰁡󰁮 󰁡󰁬󰁳󰁯 󰁢󰁥 󰁥󰁳󰁴󰁩󰁭󰁡󰁴󰁥󰁤: < 8: (AGE 󰁸 2) + 8 > 8: AGE 󰁸 3

15 󰁼 󰁐 󰁡 󰁧 󰁥  󰁥 

 

Pediatric Trauma (Not Just Small Adults)

S󰁕RG GP. 425

Monday, Oct 29 2007

󰁄󰁲. 󰁁󰁡󰁹󰁥󰁤 󰁁󰁬󰀭󰁑 󰁡󰁨󰁴󰁡󰁮󰁩 󰁡󰁨󰁴󰁡󰁮󰁩  

󰁁󰁳󰁳. 󰁐󰁲󰁯󰁦󰁥󰁳󰁳󰁯󰁲 & 󰁃󰁯󰁮󰁳󰁵󰁬󰁴󰁡󰁮󰁴 󰁰󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣 󰁳󰁵󰁲󰁧󰁥󰁲󰁹

16 󰁼 󰁐 󰁡 󰁧 󰁥  󰁥 

 

Pediatric Trauma (Not Just Small Adults)

S󰁕RG GP. 425

Monday, Oct 29 2007

󰁄󰁲. 󰁁󰁡󰁹󰁥󰁤 󰁁󰁬󰀭󰁑 󰁡󰁨󰁴󰁡󰁮󰁩 󰁡󰁨󰁴󰁡󰁮󰁩  

󰁁󰁳󰁳. 󰁐󰁲󰁯󰁦󰁥󰁳󰁳󰁯󰁲 & 󰁃󰁯󰁮󰁳󰁵󰁬󰁴󰁡󰁮󰁴 󰁰󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣 󰁳󰁵󰁲󰁧󰁥󰁲󰁹

Abdominal  ttr auma ::   ♣  3󰁲󰁤 󰁬󰁥󰁡󰁤󰁩󰁮󰁧 󰁣󰁡󰁵󰁳󰁥 󰁯󰁦 󰁴󰁲󰁡󰁵󰁭󰁡 󰁤󰁥󰁡󰁴󰁨 .   󰁯󰁦󰁴󰁥󰁮 󰁯󰁣󰁣󰁵󰁬󰁴 󰁦󰁡󰁴󰁡󰁬 󰁩󰁮󰁪󰁵󰁲󰁹 . ♣  󰁢󰁬󰁵󰁮󰁴: M󰁖A, 󰁢󰁩󰁫󰁥󰁳, 󰁳󰁰󰁯󰁲󰁴󰁳, 󰁡󰁳󰁳󰁡󰁵󰁬󰁴 .

Abdominal  ttr auma:  A Anatomic  iissues  ::   ♣  I󰁮 󰁰󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣󰁳 󰁴󰁨󰁥󰁲󰁥 󰁡󰁲󰁥 󰁬󰁡󰁲󰁧󰁥󰁲 󰁳󰁯󰁬󰁩󰁤 󰁯󰁲󰁧󰁡󰁮󰁳 󰁡󰁮󰁤 󰁬󰁥󰁳󰁳 󰁭󰁵󰁳󰁣󰁵󰁬󰁡󰁴󰁵󰁲󰁥 󰁬󰁥󰁡󰁤󰁩󰁮󰁧 󰁴󰁯 󰁣󰁯󰁭󰁰󰁡󰁣󰁴 󰁴󰁯󰁲󰁳󰁯, 󰁥󰁬󰁡󰁳󰁴󰁩󰁣 󰁲󰁩󰁢󰁣󰁡󰁧󰁥, 󰁬󰁩󰁶󰁥󰁲 & 󰁳󰁰󰁬󰁥󰁥󰁮 󰁡󰁮󰁴󰁥󰁲󰁩󰁯󰁲 .  ↑ 󰁰󰁯󰁴󰁥󰁮󰁴󰁩󰁡󰁬 󰁩󰁮󰁴󰁥󰁲󰁮󰁡󰁬 󰁩󰁮󰁪󰁵󰁲󰁹 .  󰁳󰁰󰁬󰁥󰁥󰁮>󰁬󰁩󰁶󰁥󰁲>󰁫󰁩󰁤󰁮󰁥󰁹>󰁰󰁡󰁮󰁣󰁲󰁥󰁡󰁳>󰁩󰁮󰁴󰁥󰁳󰁴󰁩󰁮󰁥 󰁳󰁰󰁬󰁥󰁥󰁮>󰁬󰁩󰁶󰁥󰁲>󰁫󰁩󰁤󰁮󰁥󰁹>󰁰󰁡󰁮󰁣󰁲󰁥󰁡󰁳>󰁩󰁮󰁴󰁥󰁳󰁴󰁩󰁮󰁥 . ♣  󰁢󰁬󰁡󰁤󰁤󰁥󰁲 󰁩󰁮󰁴󰁲󰁡󰀭󰁡󰁢󰁤󰁯󰁭󰁩󰁮󰁡󰁬 󰁭󰁯󰁲󰁥 󰁴󰁨󰁡󰁮 󰁡󰁤󰁵󰁬󰁴󰁳 .  10% 10% 󰁨󰁡󰁶󰁥 G󰁕 󰁩󰁮󰁪󰁵󰁲󰁹 . ♣  󰁬󰁯󰁷 BP 󰁬󰁡󰁴󰁥 󰁳󰁩󰁧󰁮 󰁯󰁦 󰁳󰁨󰁯󰁣󰁫 . ♣  󰁭󰁥󰁣󰁨󰁡󰁮󰁩󰁳󰁭  󰁨󰁡󰁮󰁤󰁬󰁥󰁢󰁡󰁲󰁳, 󰁨󰁡󰁮󰁤󰁬󰁥󰁢󰁡󰁲󰁳, 󰁳󰁥󰁡󰁴 󰁢󰁥󰁬󰁴 .

Abdominal  TTr auma:  A Assessment ::   ♣  󰁬󰁯󰁷 BP 󰁬󰁡󰁴󰁥 󰁳󰁩󰁧󰁮 󰁯󰁦 󰁳󰁨󰁯󰁣󰁫 . ♣  ♣  ♣  ♣  ♣ 

󰁣󰁬󰁩󰁮󰁩󰁣󰁡󰁬 󰁦󰁩󰁮󰁤󰁩󰁮󰁧󰁳 󰁵󰁮󰁲󰁥󰁬󰁩󰁡󰁢󰁬󰁥 . 󰁳󰁨󰁯󰁵󰁬󰁤󰁥󰁲 󰁴󰁩󰁰 󰁰󰁡󰁩󰁮, 󰁦󰁬󰁡󰁮󰁫 / 󰁬󰁡󰁰 󰁥󰁣󰁣󰁨󰁹󰁭󰁯󰁳󰁩󰁳 󰁥󰁣󰁣 󰁨󰁹󰁭󰁯󰁳󰁩󰁳 . 󰁕/A, N/G . 󰁲󰁥󰁡󰁳󰁳󰁥󰁳󰁳, 󰁲󰁥󰁡󰁳󰁳󰁥󰁳󰁳, 󰁲󰁥󰁡󰁳󰁳󰁥󰁳󰁳 . 󰁭󰁥󰁣󰁨󰁡󰁮󰁩󰁳󰁭   󰁨󰁡󰁮󰁤󰁬󰁥󰁢󰁡󰁲󰁳, 󰁬󰁡󰁰 󰁢󰁥󰁬󰁴

Abdominal  iimaging:   -CT  ::   ♣  󰁭󰁯󰁳󰁴 󰁷󰁩󰁤󰁥󰁬󰁹 󰁵󰁳󰁥󰁤 . ♣  󰁳󰁴󰁡󰁢󰁬󰁥 󰁰󰁴 󰁯󰁮󰁬󰁹 ♣  󰁳󰁴󰁲󰁯󰁮󰁧󰁬󰁹 󰁣󰁯󰁮󰁳󰁩󰁤󰁥󰁲 󰁩󰁮 H󰁥󰁡󰁤 I󰁮󰁪󰁵󰁲󰁹 󰁰󰁡󰁴󰁩󰁥󰁮󰁴   25% 󰁷󰁩󰁴󰁨 GCS <10 ♣  󰁩󰁮󰁳󰁥󰁮󰁳󰁩󰁴󰁩󰁶󰁥 󰁦󰁯󰁲 󰁨󰁯󰁬󰁬󰁯󰁷 󰁶󰁩󰁳󰁣󰁯󰁵󰁳 (25% 󰁳󰁥󰁮󰁳), 󰁰󰁡󰁮󰁣󰁲󰁥󰁡󰁳 (85% 󰁳󰁥󰁮󰁳). 󰀭F󰁯󰁣󰁵󰁳󰁥󰁤 󰁕󰁬󰁴󰁲󰁡󰁳󰁯󰁵󰁮󰁤:  󰁕󰁬󰁴󰁲󰁡󰁳󰁯󰁵󰁮󰁤: 󰁱󰁵󰁩󰁣󰁫 󰁡󰁢󰁤󰁯󰁭󰁩󰁮󰁡󰁬 󰁕.S 󰁬󰁯󰁯󰁫󰁩󰁮󰁧 󰁦󰁲󰁯 󰁦󰁬󰁵󰁩󰁤󰁳.

Abdominal  ttr auma:  D DPL  ::   ♣  R󰁡󰁲󰁥󰁬󰁹 󰁮󰁥󰁥󰁤󰁥󰁤 󰁩󰁮 󰁰󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣. ♣  FP 5󰀭14% ♣  ? 󰁳󰁯󰁬󰁩󰁤 󰁯󰁲󰁧󰁡󰁮󰁳, 󰁲󰁥󰁴󰁲󰁯󰁰󰁥󰁲󰁩󰁴󰁯󰁮󰁥󰁵󰁭, 󰁩󰁮󰁴󰁥󰁳󰁴󰁩󰁮󰁥 . ♣  +󰁶󰁥:   >100,000 RBC (󰁢󰁬󰁵󰁮󰁴 󰁩󰁮 󰁡󰁤󰁵󰁬󰁴, 󰁩󰁮 󰁰󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣 󰁩󰁴 󰁩󰁳 󰁣󰁯󰁮󰁴󰁲󰁯󰁶󰁥󰁲󰁳󰁩󰁡󰁬).   >5,000 (GS󰁗). ♣  󰁵󰁳󰁥: 󰁵󰁮󰁳󰁴󰁡󰁢󰁬󰁥, 󰁧󰁯󰁩󰁮󰁧 󰁴󰁯 OR 󰁡󰁮󰁹󰁷󰁡󰁹 . Abdominal  ttr auma:  M Management:   ♣  󰁳󰁰󰁬󰁥󰁥󰁮 󰁡󰁮󰁤 󰁬󰁩󰁶󰁥󰁲:   90% 󰁣󰁯󰁮󰁳󰁥󰁲󰁶󰁡󰁴󰁩󰁶󰁥: 󰁡󰁤󰁭󰁩󰁴, 󰁯󰁢󰁳󰁥󰁲󰁶󰁥, H󰁣󰁴.   󰁗󰁨󰁹?    

M󰁯󰁲󰁥 󰁦󰁡󰁴󰁡󰁬 󰁨󰁥󰁭󰁯󰁲󰁲󰁨󰁡󰁧󰁥 󰁷󰁩󰁴󰁨 󰁬󰁩󰁶󰁥󰁲 󰁩󰁮󰁪󰁵󰁲󰁩󰁥󰁳 . L󰁡󰁰 󰁩󰁮 󰁵󰁮󰁳󰁴󰁡󰁢󰁬󰁥 󰁡󰁦󰁴󰁥󰁲 󰁲󰁥󰁳󰁵󰁳 . ♣  󰁨󰁥󰁭󰁡󰁴󰁵󰁲󰁩󰁡:   G󰁲󰁯󰁳󰁳 󰁯󰁲 >20 RBC + 󰁵󰁮󰁳󰁴󰁡󰁢󰁬󰁥 → I󰁖P (󰁩󰁮󰁴󰁲󰁡󰁶󰁥󰁮󰁯󰁵󰁳 󰁰󰁹󰁬󰁯󰁧󰁲󰁡󰁭) 󰁩󰁮 OR. 17 󰁼 󰁐 󰁡 󰁧 󰁥  󰁥 

 

Pediatric Trauma (Not Just Small Adults)

S󰁕RG GP. 425

Monday, Oct 29 2007

󰁄󰁲. 󰁁󰁡󰁹󰁥󰁤 󰁁󰁬󰀭󰁑 󰁡󰁨󰁴󰁡󰁮󰁩 󰁡󰁨󰁴󰁡󰁮󰁩    

󰁁󰁳󰁳. 󰁐󰁲󰁯󰁦󰁥󰁳󰁳󰁯󰁲 & 󰁃󰁯󰁮󰁳󰁵󰁬󰁴󰁡󰁮󰁴 󰁰󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣 󰁳󰁵󰁲󰁧󰁥󰁲󰁹

>10 RBC + 󰁳󰁴󰁡󰁢󰁬󰁥 → CT 󰁣󰁹󰁳󰁴󰁯.

Bur ns  ::   ♣  󰁩󰁮󰁦󰁡󰁮󰁴󰁳 → 󰁳󰁰󰁩󰁬󰁬󰁳 > 󰁩󰁮󰁴󰁥󰁮󰁴󰁩󰁯󰁮󰁡󰁬 󰁩󰁭󰁭󰁥󰁲󰁳󰁩󰁯󰁮󰁳 . ♣  󰁯󰁬󰁤󰁥󰁲 󰁫󰁩󰁤󰁳 → 󰁦󰁬󰁡󰁭󰁥󰁳 . ♣  R󰁵󰁬󰁥󰁳 󰁯󰁦 N󰁩󰁮󰁥󰁳 󰁤󰁯󰁥󰁳󰁮󲀙󰁴 󰁷󰁯󰁲󰁫:   󰁌󰁵󰁮󰁤 & 󰁂󰁲󰁯󰁵󰁤󰁥󰁲  󰁣󰁨󰁡󰁲󰁴  󰁣󰁨󰁡󰁲󰁴 .   󰁰󰁡󰁬󰁭 = 1% ♣  󰁭󰁧󰁴 󰁳󰁡󰁭󰁥 󰁡󰁳 󰁡󰁤󰁵󰁬󰁴󰁳 . Child a abuse  ::   ( 󰁕S) . ♣  1 󰁭󰁩󰁬󰁬󰁩󰁯󰁮 󰁣󰁯󰁮󰁦󰁩󰁲󰁭󰁥󰁤 󰁣󰁡󰁳󰁥󰁳 / 󰁹󰁥󰁡󰁲 (󰁕S) ♣  󰁨󰁩󰁧󰁨 󰁩󰁮󰁤󰁥󰁸 󰁯󰁦 󰁳󰁵󰁳󰁰󰁩󰁣󰁩󰁯󰁮 . ♣  RF: 󰁰󰁯󰁶󰁥󰁲󰁴󰁹, 󰁳󰁩󰁮󰁧󰁬󰁥 󰁰󰁡󰁲󰁥󰁮󰁴, 󰁳󰁵󰁢󰁳󰁴󰁡󰁮󰁣󰁥 󰁡󰁢󰁵󰁳󰁥, <2 󰁹󰁥󰁡󰁲󰁳, 󰁤󰁩󰁳󰁡󰁢󰁩󰁬󰁩󰁴󰁹, 󰁬󰁯󰁷 󰁢󰁩󰁲󰁴󰁨 󰁷󰁥󰁩󰁧󰁨󰁴 . ♣  󰁣󰁵󰁴󰁡󰁮󰁥󰁵󰁯󰁳 󰁩󰁮󰁪󰁵󰁲󰁩󰁥󰁳 󰁭󰁯󰁳󰁴 󰁣󰁯󰁭󰁭󰁯󰁮 . ♣  󰁤󰁥󰁡󰁴󰁨 2󰂰󰁴󰁯 󰁨󰁥󰁡󰁤 & 󰁡󰁢󰁤󰁯󰁭󰁩󰁮󰁡󰁬 󰁴󰁲󰁡󰁵󰁭󰁡 . ♣  󰁩󰁮󰁴󰁥󰁲󰁶󰁩󰁥󰁷 󰁣󰁨󰁩󰁬󰁤 & 󰁰󰁡󰁲󰁥󰁮󰁴 󰁳󰁥󰁰󰁡󰁲󰁡󰁴󰁥󰁬󰁹 . Child a abuse:  C Clues  ::   History

♣  ♣  ♣  ♣  ♣ 

󰁳󰁴󰁯󰁲󰁹 ≠ 󰁩󰁮󰁪󰁵󰁲󰁩󰁥󰁳 . 󰁨󰁩󰁳󰁴󰁯󰁲󰁹 󰁣󰁨󰁡󰁮󰁧󰁩󰁮󰁧 . 󰁩󰁮󰁪󰁵󰁲󰁹 ≠ 󰁤󰁥󰁶󰁥󰁬󰁯󰁰󰁭󰁥󰁮󰁴 . 󰁤󰁥󰁬󰁡󰁹 󰁳󰁥󰁥󰁫󰁩󰁮󰁧 󰁨󰁥󰁬󰁰 . 󰁩󰁮󰁡󰁰󰁰󰁲󰁯󰁰󰁲󰁩󰁡󰁴󰁥 󰁬󰁥󰁶󰁥󰁬 󰁯󰁦 󰁣󰁯󰁮󰁣󰁥󰁲󰁮 . Physical Exam ♣  󰁭󰁵󰁬󰁴󰁩󰁰󰁬󰁥 󰁯󰁬󰁤 󰁡󰁮󰁤 󰁮󰁥󰁷 󰁢󰁲󰁵󰁩󰁳󰁥󰁳 . ♣  󰁰󰁯󰁳󰁴󰁥󰁲󰁩󰁯󰁲 󰁲󰁩󰁢 󰁢󰁯󰁮󰁥, 󰁳󰁴󰁥󰁲󰁮󰁵󰁭 󰁢󰁯󰁮󰁥, 󰁳󰁰󰁩󰁲󰁡󰁬 󰁢󰁯󰁮󰁥 < 3 . ♣  󰁩󰁭󰁭󰁥󰁲󰁳󰁩󰁯󰁮 󰁢󰁵󰁲󰁮󰁳, 󰁣󰁩󰁧󰁡󰁲󰁥󰁴󰁴󰁥 .

Child a abuse:  H Head  iin j ju ur y  ::   ♣  󰁢󰁬󰁵󰁮󰁴, 󰁡󰁣󰁣󰁥󰁬󰁥󰁲󰁡󰁴󰁩󰁯󰁮/󰁤󰁥󰁣󰁥󰁬󰁥󰁲󰁡󰁴󰁩󰁯󰁮 . ♣  31% 󰁭󰁩󰁳󰁳󰁥󰁤, 28% 󰁲󰁥󰀭󰁩󰁮󰁪󰁵󰁲󰁥󰁤 . ♣  󰁦󰁲󰁡󰁣󰁴󰁵󰁲󰁥󰁳:   󰁢󰁩󰁬󰁡󰁴󰁥󰁲󰁡󰁬, 󰁣󰁲󰁯󰁳󰁳 󰁳󰁵󰁴󰁵󰁲󰁥󰁳, 󰁤󰁩󰁡󰁳󰁴󰁡󰁴󰁩󰁣, 󰁮󰁯󰁮󰀭󰁰󰁡󰁲󰁩󰁥󰁴󰁡󰁬 . ♣  IC 󰁩󰁮󰁪󰁵󰁩󰁲󰁥󰁳:   SAH, 󰁳󰁵󰁢󰁤󰁵󰁲󰁡󰁬, ICH, 󰁥󰁤󰁥󰁭󰁡 . ♣  CT 󰁩󰁦 󰁳󰁵󰁳󰁰󰁥󰁣󰁴 . Child a abuse:  M Management ::   ♣  D󰁯󰁣󰁵󰁭󰁥󰁮󰁴 . ♣  󰁦󰁵󰁬󰁬 P/E (󰁲󰁥󰁣󰁴󰁡󰁬, 󰁧󰁥󰁮󰁩󰁴󰁡󰁬). ♣  P󰁨󰁯󰁴󰁯󰁧󰁲󰁡󰁰󰁨 . ♣  B/󰁗: CBC, PT/PTT, LFT󰁳, 󰁬󰁩󰁰󰁡󰁳󰁥, 󰁕/A . ♣  󰁳󰁫󰁥󰁬󰁥󰁴󰁡󰁬 󰁳󰁵󰁲󰁶󰁥󰁹 . ♣  CT 󰁨󰁥󰁡󰁤, 󰁡󰁢󰁤󰁯󰁭󰁩󰁮󰁡󰁬 󰁰󰁲󰁮 ♣  C󰁨󰁩󰁬󰁤 P󰁲󰁯󰁴󰁥󰁣󰁴󰁩󰁯󰁮.

1󰀸 󰁼 󰁐 󰁡 󰁧 󰁥  󰁥 

 

Pediatric Trauma (Not Just Small Adults)

S󰁕RG GP. 425

Monday, Oct 29 2007

󰁄󰁲. 󰁁󰁡󰁹󰁥󰁤 󰁁󰁬󰀭󰁑 󰁡󰁨󰁴󰁡󰁮󰁩 󰁡󰁨󰁴󰁡󰁮󰁩  

󰁁󰁳󰁳. 󰁐󰁲󰁯󰁦󰁥󰁳󰁳󰁯󰁲 & 󰁃󰁯󰁮󰁳󰁵󰁬󰁴󰁡󰁮󰁴 󰁰󰁥󰁤󰁩󰁡󰁴󰁲󰁩󰁣 󰁳󰁵󰁲󰁧󰁥󰁲󰁹

Abdominal  ttr auma:  F FAST  ::   ♣  󰁍󰁵󰁲󰁰󰁨󰁹. 󰁅󰁭󰁥󰁲󰁧 󰁍󰁥󰁤 󰁊 2001󰀺 󰁲󰁥󰁶󰁩󰁥󰁷 󰁲󰁥󰁶󰁩󰁥󰁷     30󰀭87% 󰁳󰁥󰁮󰁳󰁩󰁴󰁩󰁶󰁥, 70󰀭100% 󰁳󰁰󰁥󰁣󰁩󰁦󰁩 2001󰀺  ♣  󰁌󰁯󰁩󰁳󰁥󰁬󰁬󰁥. 󰁁󰁮󰁮󰁡󰁬󰁳 󰁅󰁭󰁥󰁲󰁧 󰁍󰁥󰁤 2001󰀺    󰁳󰁥󰁮󰁳 55%, 󰁳󰁰󰁥󰁣 83%, NP󰁖 50%, PP󰁖 86% ♣  󰁢󰁯󰁴󰁴󰁯󰁭 󰁬󰁩󰁮󰁥:   󰁩󰁮󰁳󰁥󰁮󰁳󰁩󰁴󰁩󰁶󰁥, 󰁴󰁯󰁯 󰁳󰁰󰁥󰁣󰁩󰁦󰁩󰁣 .   FF ≠ 󰁬󰁡󰁰, 󰁮󰁯 FF ≠ 󰁮󰁯 󰁳󰁩󰁧󰁮 󰁯󰁲󰁧󰁡󰁮 󰁩󰁮󰁪󰁵󰁲󰁹 .   󰁭󰁡󰁹 󰁲󰁥󰁰󰁬󰁡󰁣󰁥 DPL 󰁩󰁮 󰁵󰁮󰁳󰁴󰁡󰁢󰁬󰁥 󰁰󰁴.

To Get The Slides 󰁨󰁴󰁴󰁰󰀺󰀯󰀯󰁦󰁡󰁣󰁵󰁬󰁴󰁹󰀮󰁫󰁳󰁵󰀮󰁥󰁤󰁵󰀮󰁳󰁡󰀯󰁱󰁡󰁨󰁴󰁡󰁮󰁩

1󰀹 󰁼 󰁐 󰁡 󰁧 󰁥  󰁥