Trauma and Injury Prevention
Trauma content emphasizes mechanism-based prediction of injury and a structured primary survey with spinal motion restriction when indicated. Candidates must recognize that children have a larger head-to-body ratio, more compliant ribs, and a pliable skeleton, so serious internal injury can occur without external signs. Understand the approach to head injury (stratifying low-risk for imaging), abdominal trauma (solid organ injury from blunt mechanisms), and the recognition of non-accidental trauma patterns.
Key concepts include the lethal triad (hypothermia, acidosis, coagulopathy), damage-control resuscitation, and the principle that hypotension in a child with trauma signals substantial blood loss. Know indications for focused assessment with sonography, when to obtain imaging, and the role of analgesia and tetanus prophylaxis.
Traps: assuming a normal examination excludes intra-abdominal injury; missing a second injury after finding one; and overlooking the mechanism (e.g., a low-height fall producing severe injury should prompt evaluation for abuse). Another trap is failing to immobilize the cervical spine during initial airway management when mechanism warrants it.
Worked example: a school-age child struck by a car with a distended abdomen and tachycardia but normal blood pressure should be treated as having hemorrhagic shock; obtain IV access, begin resuscitation, and pursue imaging and surgical consultation rather than waiting for hypotension. Rule of thumb: mechanism plus physiology guides urgency more than a single physical finding. Injury prevention counseling-car seats, helmet use, safe storage-is a core responsibility.