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Pediatric Surgery (Pg 68-81) - page 16 / 33

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Blood pressure is not a sensitive sign for shock.  Children can compensate for hypovolemia very effectively by increasing PVR.  Hypotension develops only after more than 25% of the total blood volume is lost.

Children are more vulnerable to head injury

Children have a greater risk of hypothermia

Children have a quite flexible skeleton, therefore major internal organ damage without overlying fractures may be possible.

Injury to the epiphyseal growth plate can inhibit growth and cause deformity.

Gastric distention is more common in children b/c they tend to swallow air.

More likely to have lasting psychological problems

Head Trauma

Major cause of death of injured children. A CT scan provides excellent anatomic definition and should be obtained promptly for a suspected injury.  Intracranial pressure is minimized by hyperventilation to produce hypocapnia (which limits cerebral vasodilation) and by fluid restriction and diuretics.

Chest Trauma

Most injuries to the chest can be managed non-operatively with chest tube drainage and supportive care. Indications for surgery are massive, continued blood loss or uncontrolled air leaks through chest tubes; pericardial tamponade; and suspected injury to the esophagus, diaphragm, and great vessels.

Abdominal Trauma

Abd surgery after trauma is required for a child with a distended, tense abd or free intraperitoneal air on X-ray.  These finding indicate either massive intraabdominal bleeding or a perforated viscus. If abd injury is suspected a CT scan is indicated. Every effort should be made to salvage the spleen, regardless of whether surgery is required b/c children are particularly susceptible to overwhelming postsplenectomy sepsis.

UT Injuries

Hematuria after injury indicates a CT scan. Surgical repair is needed if there is any extravasation of urine from the kidneys or bladder, or if the major renal vessels are injured.  Presence of gross blood at the urethral meatus necessitates an urethrogram to r/o urethral injury before a Foley catheter is inserted.

Burns

One-third of burn injuries are caused by child abuse.

When calculating the % of body surface area burns in children the “rule of nines” does not apply. Must use the Lund and Browder chart (fig 2-30).

Hospital admission is advised if a second-degree burn involves more than 10 % of the body SA or if a third-degree burn covers more than 2%.  Inpatient care is also recommended for significant burns of the hands, feet, face, or perineum, and for children younger than 2 years old.

Child Abuse

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