ITLS - International Trauma Life Support Pediatric Trauma Considerations Questions and Answers 1 — Questions and Answers
Question 1: The Pediatric Assessment Triangle (PAT) is a rapid assessment tool used to form a general impression of a sick child. Which of the following are the three components of the PAT?
- Airway, Breathing, Circulation
- Appearance, Work of Breathing, Circulation to Skin (Correct answer)
- Level of Consciousness, Motor Response, Pupil Reaction
- Heart Rate, Respiratory Rate, Blood Pressure
Correct answer: Appearance, Work of Breathing, Circulation to Skin
The Pediatric Assessment Triangle (PAT) consists of three key observational components: Appearance (evaluating tone, interactiveness, consolability, look/gaze, and speech/cry), Work of Breathing (assessing for abnormal sounds, positioning, and retractions), and Circulation to Skin (checking for pallor, mottling, or cyanosis). This tool allows for a rapid 'from the doorway' evaluation without touching the patient.
Question 2: When positioning an infant trauma patient for airway management, what modification is often necessary to achieve a neutral airway alignment?
- Placing a large roll under the neck to achieve hyperextension.
- Flexing the head forward onto the chest to open the posterior pharynx.
- Placing padding under the shoulders and torso. (Correct answer)
- Turning the head to the side to allow for drainage.
Correct answer: Placing padding under the shoulders and torso.
Infants and young children have a proportionally large occiput (back of the head), which causes passive neck flexion when they are laid supine. To counteract this and achieve a neutral or 'sniffing' position that properly aligns the airway axes, padding should be placed under the shoulders and upper torso.
Question 3: A 5-year-old child weighing 20 kg is in decompensated hemorrhagic shock following blunt abdominal trauma. According to ITLS guidelines, what is the correct initial isotonic crystalloid fluid bolus?
- A 1,000 mL bolus administered over 30 minutes.
- A 200 mL bolus (10 mL/kg) administered as quickly as possible.
- A 500 mL bolus administered as quickly as possible.
- A 400 mL bolus (20 mL/kg) administered as quickly as possible. (Correct answer)
Correct answer: A 400 mL bolus (20 mL/kg) administered as quickly as possible.
The standard initial fluid bolus for a pediatric trauma patient in shock is 20 mL/kg of an isotonic crystalloid solution (like Normal Saline or Lactated Ringer's). For a 20 kg child, this calculates to 20 kg * 20 mL/kg = 400 mL. This bolus should be administered rapidly.
Question 4: Which of the following best describes a key physiological difference in how children compensate for hemorrhagic shock compared to adults?
- Children become hypotensive very early in the shock process.
- Bradycardia is the primary and most reliable initial sign of shock.
- Children can maintain a normal blood pressure despite significant blood loss. (Correct answer)
- Peripheral vasodilation is the main compensatory mechanism.
Correct answer: Children can maintain a normal blood pressure despite significant blood loss.
Children have very effective compensatory mechanisms, including intense vasoconstriction and an increased heart rate. This allows them to maintain a normal systolic blood pressure until they have lost a substantial percentage of their circulating blood volume (up to 45%). Hypotension is therefore a late and ominous sign of decompensated shock in a child. Tachycardia is the earliest sign.
Question 5: A 6-year-old pedestrian is struck by a motor vehicle. The provider should maintain a high index of suspicion for Waddell's Triad, which is a classic pattern of injuries consisting of:
- Head injury, cervical spine fracture, and pelvic fracture.
- Femur fracture, intra-abdominal/thoracic injury, and contralateral head injury. (Correct answer)
- Bilateral femur fractures and a significant chest injury.
- Clavicle fracture, splenic laceration, and closed head injury.
Correct answer: Femur fracture, intra-abdominal/thoracic injury, and contralateral head injury.
Waddell's Triad describes the three-part injury pattern commonly seen in pediatric pedestrian-versus-vehicle collisions. The sequence involves: 1) The car's bumper striking the femur; 2) The child's torso striking the hood or fender, causing thoracic or abdominal injuries; and 3) The child being thrown to the ground, resulting in a head injury on the opposite side of the initial impact.
Question 6: A 7-year-old falls off his bicycle, striking the handlebar directly into his upper abdomen. He is now tachycardic, pale, and has significant epigastric tenderness. In pediatric blunt abdominal trauma, which solid organ is most frequently injured?
- Spleen (Correct answer)
- Bladder
- Pancreas
- Kidneys
Correct answer: Spleen
In pediatric blunt abdominal trauma, the solid organs are most at risk. The spleen and liver are the most commonly injured organs due to their size and location. The spleen is particularly vulnerable because of its rich blood supply and relatively unprotected position in the left upper quadrant.
ITLS - International Trauma Life Support Pediatric Trauma Considerations Questions and Answers 1
The Pediatric Assessment Triangle (PAT) is a rapid assessment tool used to form a general impression of a sick child.
Which of the following are the three components of the PAT?