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TRUMA

This document provides information about a lecture on congenital diaphragmatic hernia (CDH) given on March 14, 2023. The lecture was given by Dr. Omar Ajaj to 5th year medical students at Anbar University College of Medicine. The document discusses the incidence and types of CDH, methods of prenatal and postnatal diagnosis, clinical presentation of CDH in newborns, and treatment approaches including resuscitation, surgery, and management of respiratory distress.

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zainabd1964
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36 views56 pages

TRUMA

This document provides information about a lecture on congenital diaphragmatic hernia (CDH) given on March 14, 2023. The lecture was given by Dr. Omar Ajaj to 5th year medical students at Anbar University College of Medicine. The document discusses the incidence and types of CDH, methods of prenatal and postnatal diagnosis, clinical presentation of CDH in newborns, and treatment approaches including resuscitation, surgery, and management of respiratory distress.

Uploaded by

zainabd1964
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Attendance: Obligatory

Type of lecture: theory 4


Place : College of medicine –Anbar University .
Date : 14 -March.- 2023.
Time : 12:30 – 01:30 PM.
Students: 5th year / college of medicine / Anbar University
By : Dr.Omar A. Ajaj- M.B.Ch.B. - F.I.C.M.S. -Associate professor-
pediatric surgeon.
E. mail: [email protected]
Congenital Diaphragmatic Hernia
(CDH)
 The incidence of CDH has been reported
as high as 1 in 2000 births.
 The posterolateral ‘Bochdalek’ hernia
accounts for 90% of all diaphragmatic
hernia cases.

 The (10%) are the anterior ‘Morgagni’


hernia .
 The majority of posterolateral CDH are
left sided (85%), with right sided (13%)
and bilateral (2%).
DIAGNOSIS
 Prenatal Diagnosis:-
 A-Ultrasound of the fetal chest.
 B-Fetal magnetic resonance imaging (MRI).
Clinical Presentation
 Newborns with CDH typically present with
respiratory distress, with associated low Apgar
scores.
 On physical examination, infants will often
have a scaphoid abdomen and an increased
chest diameter. The point of maximal cardiac
impulse is often displaced, suggesting
mediastinal shift. Bowel sounds may be
auscultated within the chest cavity with a
decrease in breath sounds bilaterally.
 The diagnosis of CDH is typically
confirmed by a chest radiograph
demonstrating intestinal loops within
the thorax .
TREATMENT
 Resuscitation and Stabilization.
 SURGERY.
Pathophysiology of pediatric trauma

Trauma is the leading cause of morbidity


and mortality in children

• While blunt injuries are more common,


penetrating injuries are more lethal.

• Blunt injuries outnumber penetrating injuries in


children by a ratio of 12 : 1.
Anatomically
• Children have thin layers of muscle, fat, and fascia
• More elastic connective tissue, and a pliable
skeleton.
• Ribs cover only the upper most portion of the
abdomen.
• Pelvis is shallow, lifting the bladder into the
abdomen.
• Small size of the abdomen predisposes the child
to multiple rather than single injuries
• The most frequently injured body regions in
childhood trauma are
1.Lower extremities,
2.Head,
3.Neck
4.Abdomen.
The Waddell triad of injuries Children riding bicycles
lap belts
Handlebar injuries
• liver,
• Spleen
• Kidney,
• Pancreas,
• And small bowel
perforation.
Basic Life Support

• Prehospital medical care for the pediatric trauma


patient .
1-Danger and safety
2-Response
3-Basic airway management
4-Breathing
5-Identifying cardiac arrest (CPR)
6-Call an ambulance
7-Circulation (Bleeding control)
8-Spine stabilization
9-Temperature maintenance.
ATLS

-Primary Survey
• Airway: clear and maintain, protect cervical spine
• Breathing: ventilate and oxygenate, fix chest wall
• Circulation: 1st …..control bleeding, 2nd ….restore
volume
• Disability: GCS and pupils, call the neurosurgeon
• Exposure: avoid hypothermia
• Foley catheter unless contraindicated(Meatal
blood, scrotal hematoma, high-riding
prostate)
• Gastric tube unless contraindicated(CSF oto-
rhinorrhea, basilar skull fracture, midface
instability)
-Secondary Survey
• History and physical: SAMPLE history,
complete examination
• Imaging studies: plain radiographs(Chest,
pelvis, lateral cervical spine; others as
indicated)
• Special studies(FAST,CT)
• The triad of death in trauma patients:
- Coagulation abnormalities,
- Acidosis
- Hypothermia: can lead to arrhythmias,
coagulation abnormalities, and acidosis
MANAGEMENT OF PAIN
Resuscitation
• Any child initially seen with major trauma
should receive breathing support with high-
concentration oxygen.
• The child with significant trauma will require
volume resuscitation if signs of hypovolemic
shock are present.
Signs and Symptoms
• Confusion, weakness
• Dizziness
• Hypotension (Late sign)
• Pale, cool, clammy skin
• Dark-tarry stools
• Heart rate
• Distal pulses
• Capillary refill
• Urine output
• Fontanel
• Eyes
• Tearing
• Mucosa
• Simple hypovolemia usually responds to 20–
40 mL/kg of warmed lactated Ringer’s
solution.
• However, frank hypotension (defined clinically
by a systolic blood pressure less than 70
mmHg + twice the age in years) typically
requires 40–60 mL/kg of warmed lactated
Ringer’s solution followed by 10–20 mL/kg of
warmed packed red blood cells.
• Urinary output should be measured as an
indication of tissue perfusion.
• The minimum urinary output that indicates
adequate renal perfusion is 2 mL/kg/h in
infants, 1 mL/kg/h in children, and 0.5
mL/kg/h in adolescents.
• systolic hypotension is a late sign of shock and
may not develop until 30–35% of circulating
blood volume is lost.
Foreign body (FB) ingestions

• The vast majority of ingestions in children are


accidental.
• 80%–90% of FBs in the gastrointestinal (GI)
tract are passed spontaneously without
complications.
The common sites of FB impaction
• 1-The esophagus is the narrowest portion of
the alimentary tract and is thus a common site
for FB impaction.
• 2-Pylorus.
• 3-C shape of duodenum.
• 4-Iliocecal valve.
• The vast majority of ingestions occur in the six
months to three years age.

• Battery FB in the esophagus need urgent


intervention, while it confirmed distal to the
esophagus mostly need observation.
• Esophageal batteries lead to tissue injury
through:
• 1- Pressure necrosis,
• 2-Release of a low voltage electric current,
• 3- Leakage of an alkali solution, which causes
a liquefaction necrosis.
• Large foreign bodies(>6 cm in length) are
unlikely to pass through the duodenum and
the ileocecal valve.
• Sharp or pointed foreign bodies(such as safety
pins, nails, hair-pins, screws) sharp or pointed
FBs can cause perforation in 15%–35% of
patients.
MANAGEMENT
• History-taking and physical examination are
the basic components of an initial assessment.

• Useful aspects of the history-taking include


symptoms, type of foreign body, timing of
presentation, and associated conditions.
• The initial presentation can vary from the child
being completely asymptomatic to a variety of
symptoms

• Radiopaque objects can be detected on the


anteroposterior (AP) and lateral radiographs ,
while radiolucent objects may require a
gastrografin UGIT contrast study or
esophagoscopy .
Indication of form body removal
• 1- Any esophageal F.B.
• 2- GIT foreign bodies with
complication(obstruction, perforation,
fistulation,
• 3-Magnets (esophagus or stomach, multiple
magnets may appear to be attached at a
single point)
• 4-Bezoars.
• A bezoar is a tight collection of undigested
material that may often present as a gastric
outlet or intestinal obstruction.
• The diagnosis may be confirmed on plain
radiographs, upper gastrointestinal contrast
studies, or endoscopy.
• Medical management, endoscopic removal ,or
operation is necessary.
• Phytobezoars are made up of undigested
vegetable matter.
• Trichobezoars are made up of swallowed hair.
• A lacto-bezoar is an aggregation of undigested
milk.
THANK YOU

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