Multiprofessional Critical Care Review: Pediatric 2024 (MCCRCP24ON)-Trauma and Burns-Brief Presentation

Trauma and Burns-Brief Presentation

Pdf Summary

The document is a comprehensive summary of guidelines and important considerations for managing traumatic brain injury (TBI), spinal cord injury (SCI), and burns, primarily in pediatric patients, as presented by Dr. Ana Lia Graciano.<br /><br />For TBI, key management metrics include the Glasgow Coma Scale (GCS), cerebral perfusion pressure (CPP), and cerebral blood flow (CBF). The 2019 guidelines emphasize the pathways and targets for severe TBI management which include monitoring intracranial pressure (ICP) and brain tissue partial pressure of oxygen (PbrO2). Immediate medical responses to impending herniation, such as hyperventilation, mannitol, and hypertonic saline administration, are critical.<br /><br />In cases of SCI, pediatric patients are particularly vulnerable due to anatomical and physiological factors. The guidelines recommend imaging (X-rays, CT, MRI) based on symptoms and injury mechanisms. The SCIWORA (Spinal Cord Injury Without Radiologic Abnormality) syndrome, characterized by clinical SCI findings without imaging abnormalities, requires MRI for cord edema identification. SCI management includes maintaining spinal perfusion pressure and addressing autonomic dysreflexia and neurogenic shock, characterized by hypotension and bradycardia due to disrupted sympathetic control.<br /><br />Burn management includes fluid resuscitation using the Parkland and Galveston Shriner’s formulas. Early airway stabilization is crucial in inhalation injuries, which can cause severe airway obstructions. Carbon monoxide (CO) and cyanide toxicity, common in burn patients due to incomplete combustion, impair oxygen delivery and cellular metabolism. CO shifts the oxygen dissociation curve, and cyanide inhibits cytochrome oxidase, blocking cellular respiration. COHb levels are measured by co-oximetry, and treatment involves 100% oxygen and potentially hyperbaric oxygen. Cyanide toxicity requires rapid decontamination and empirical treatment with hydroxocobalamin.<br /><br />Overall, the emphasis is on accurate diagnosis, timely intervention, and adherence to established guidelines to mitigate complications and improve outcomes in pediatric trauma and burn cases.

Keywords

Traumatic Brain Injury

Spinal Cord Injury

Burns

Pediatric Patients

Glasgow Coma Scale

Intracranial Pressure

SCIWORA

Fluid Resuscitation

Carbon Monoxide Toxicity

Cyanide Toxicity

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