Diseases, Disorders information

Trauma; the scenario I’m going to present to you is kind of an abbreviated advanced trauma/life support scenario. What you want to do is pick up injuries that are likely to be life threatening or cause long term morbidity quickly and treat them effectively and resuscitate each problem as you discover it. After the patient has been stabilized, you are going to go back and do a little more thorough exam with a secondary survey, and then begin definitive therapy.
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The primary survey; it’s very easy to get distracted by the fractured femur sticking out of the thigh, the foot that’s twisted on backwards. Other than blood loss, that’s not going to kill them. What’s going to kill them is the fact that while you are looking at their ankle they quit breathing. So be very systematic in your assessment; airway, breathing, maintain cervical spine precautions with the airway. Cervical spine injuries in children with survivable injuries are relatively uncommon. That doesn’t mean you should ignore them. I would not let someone asphyxiate because you are concerned about intubating them. Breathing; listen to the lungs for asymmetry. Think about pneumothorax, hemothorax. Circulation; IV access and fluid resuscitation. Remember you can put interosseus needles in, using bone marrow needles, up to the age of six and maybe even a little bit beyond. It may be very effective in initial fluid resuscitation. If somebody has a crushing chest injury, be suspicious of pericardial effusions and the need for pericardial centesis. In keeping with the ABC’s, we end up with D which stands for disability, which really reflects the neurologic status. Advanced trauma life support talks about the AVPU system of assessing the level of consciousness. A, being alert, V means that they respond to verbal commands, P to painful, and U means they are unresponsive.
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Pupillary response and lateralizing weakness; you are looking for very gross neurologic changes. You are not writing letters in the palm of their hand and asking them what they are. This is a very quick neurologic survey to make sure that they don’t have any potentially life threatening or long term morbidity-threatening problems.