Kaitlyn Crow

Mr. Ratliff
ISM-1
15 November 2019
Trauma Surgery
Research Assessment #11

Daley, Brian J. “Considerations in Pediatric Trauma.” ​Overview, Epidemiology, Specific Injuries​,

9 Nov. 2019, https://emedicine.medscape.com/article/435031-overview.

In the past, I have focused on researching the lifestyles and qualities of medical
professionals, so I chose to focus this assessment on the trauma cases themselves. After speaking
to other surgeons during my first mentor visit, I realized how unprepared I was regarding what to
expect with pediatric trauma. This article focuses on the most common types of pediatric
traumas, overviewing their qualities and statistics.
I focused on the parts of the article that discussed orthopedic trauma injuries. The first of
which was trauma to the spinal cord, which is so dangerous that it is assumed in every trauma
case. I have observed this shadowing the EMTs last year, where any patient that was in a car
crash or a fall received stabilization of the neck and spine. I am familiar with these types of
injuries, but I had never heard of SCIWORA syndrome (spinal cord injury without radiological
abnormality), which is unique to pediatric trauma cases. Nerves within the spine may stretch
during trauma because vertebrae do not completely calcify until adulthood, causing them to be
elastic. There is no clear evidence of this process, so the surgeon must be extremely careful to
check for this during surgery. The slight elasticity of child bones, especially the vertebrae, can
lead to ligament and joint stretching without tearing. This makes a lot of sense and explains why
children experience sprains more often than adults. To date I have only studied adult medical
conditions, and I am beginning to the extent to which pediatrics can differ from adult medicine.
The article also discusses pediatric trauma to the neck, specifically the first two cervical
vertebrae. In penetrating injuries to the neck, there seems to be some debate over whether to
prioritize the front or back half of the body. The oropharyngeal region (mouth and throat)
receives a large blood supply and can bleed out very quickly. Injury to this region can also
compromise the child’s ability to eat and breathe naturally in the future. However, the back of
the neck has vital nerves than when damaged, can lead to full body paralysis. The consensus
seems to be to prioritize any injuries to major arteries, then it is up to the surgeon to decide what
to operate on first. Decisions like these can mean choosing whether a child must eat and breathe
from tubes for life or never walk again. As I emphasized in my research presentation, choices
like these are what make trauma surgery so difficult.
 The article also taught me some basic procedural parts of assessing trauma patients. As
previously mentioned, the spine is always stabilized in any major injury, whether it appears
damaged or not. Also, distal (far away from the body core) pulses must be taken in every limb,
because a limb may look fine but in reality is not receiving blood. If this is not done, limbs may
need to be amputated. In addition, certain situations can cause very predictable traumas, which is
why it is so important to obtain the cause of an injury from the EMTs or guardians. For instance,
seat belts often lead to lumbar fractures and hollow visceral organ (stomach, spleen, bowel. etc.)
injuries. Since conditions like these can be so predictable, trauma surgeons are never advised to
start assessing an injury until they know its cause.
Overall, this article gave me a great idea of what to expect on my trauma rotations. I will
be much more prepared when the medical team starts naming out conditions and treatments.