2. Childhood Injuries Number one cause of death and disability in children over the age of 1 –25% are intentional! Pay close attention to discrepancies between injury presentations and MOI

4. Respiratory Differences Tongue and pharyngeal tissue softer and larger –more prone to edema Airway smaller –smaller amounts of blood and mucus may occlude the airway –flexion or hyperextension of the neck may cause airway obstruction Infants are obligatory nose breathers –be wary of nasal obstruction

6. Differences in Respiratory System (con’t) Trachea shorter Rely on diaphragm for breathing Immature intracostal muscles –rely more on diaphragm movement than intracostals for breathing –excessive gastric air will affect the child’s ability to ventilate adequately

8. Respiratory System (con’t) Pliable chest wall –can have a lot of internal injuries without signs of rib fractures Faster respiratory rate –Because of greater rates and immature intercostals, children become fatigued a lot quicker- watch out for respiratory failure! –Watch for nasal flaring or retractions –cyanosis is a late sign

9. Differences in Cardiovascular System Blood pressure lower –poor sign of shock –can compensate for up to a 50% blood loss –Watch for mottled skin! Heart rate faster –always get apical hr- watch for bradycardia! Circulating blood volume 80ml/kg –have less blood!

11. Neurological Differences Increased metabolic demands –anxiety can increase metabolic demands Head is larger and heavier Cranium thinner and more pliable

12. Additional Characteristics (con’t) Susceptible to increases in intracranial pressure Neck muscles and ligaments weaker Bony spine flexible, spinal ligaments

14. History Identify caregiver Immunization status Child’s weight Air bag deployed

15. Spinal Cord Injury Significant spinal cord injury can occur with no evidence of bony damage or fracture on radiographic film –SCIWORA syndrome!