Paediatric Neuro Trauma
Christine Clements
Outline
PAEDIATRIC NEURO-TRAUMA
Christine Clements
Secondary Injury
Hypoxia
Hypotension
Increased Intracranial Pressure
Modified Glasgow Coma Score for paediatric patients
Infant best verbal response
5 coos babbles
4 irritable cry
3 cries to pain
2 moans to pain
1 no response
Children < 4 year best verbal response
5 orientated smiles interacts follows objects
4 confused disorientated uncooperative
3 inappropriate words persistent cry inconsolable inconsistent awareness etc
3 month old in MVA
Unrestrained passenger
LOC 5 minutes
No neurological deficit
Assessed at peripheral Hospital
Rt. parietal skull #
12 mm Extradural Haematoma
Urgent transfer to tertiary hospital
Evacuation of haematoma and elevation of skull #
Tear of sagital and transverse sinus
Cardiac arrest
Blood transfusion
Venous infarct
Sagital sinus thrombosis
Sub dural collections
3 months later …..
Left hemiparesis
Developmental delay
Eating difficulty
Significant skull defect
Ongoing Problems
Intellect
Emotions
Control
Fatigue
Headaches
Seizures
Key Points
Listen to the Parents
Always maintain a high level of suspicion
Early and accurate diagnosis is essential
Refer to protocols and guidelines
Normal CT does not exclude problems
Rapid resuscitation and early transfer to children's trauma centre
A deteriorating child requires intubation prior to transfer
Do not over infuse and use hypotonic solution > 2 yrs
Avoid measures that decrease ICP at expense of cerebral blood flow
Prevention of
Primary Injury
Secondary Injury
|
Ministry of Health
