MedBugs: SAQ #354

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Case: Paediatric blunt chest trauma

You are the resuscitation consultant in a paediatric major trauma centre. A 12-year-old girl is brought in by her parents after crashing while landing from a jump on a motorbike and hitting the handlebars with her chest. She is complaining of severe pain and shortness of breath. Observations on arrival are HR 139 bpm, BP 90/42 mmHg, RR 36 bpm, sats 94% on 15 L NRB, GCS 15.

1. List (3) important radiological features on the CXR. 3 marks

She continues to complain of left lower chest pain and has some tenderness when palpating her pelvis. Her haemodynamics are unchanged. Your team wishes to apply a pelvic binder, but the pelvic immobilisation device is too large.

2. State (2) options to stabilise the pelvis. 2 marks

The pelvis is now immobilised.

3. State (5) resuscitation priorities, with a focus on management of circulation. 5 marks

You decide that an ICC needs to be placed.

4. Complete the table below regarding ICC insertion in this scenario. 3 marks

5. List (2) features stating how utility of eFAST POCUS is different to adult care 2 marks

During the resuscitation, her parents request to stay to support her. Your department tries to adhere to the ‘family presence in resuscitation’ principle.

6. List (3) requirements to optimise parental presence in the resuscitation room. 3 marks

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