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A 9-year-old boy sustained a traumatic brain injury and right lower extremity trauma in an accident involving a motor vehicle and a pedestrian. Initial evaluation in the emergency department reveals an obtunded patient who is breathing spontaneously and withdraws appropriately to painful stimuli. After initial resuscitation and stabilization, a CT scan reveals a right parietal intracranial hemorrhage. Radiographs of the swollen right thigh are shown in Figures 32a and 32b. Management of the fractured femur should ultimately consist of
immediate hip spica casting.
closed reduction and percutaneous pin fixation supplemented by a hip spica cast.
placement in 90-90 traction after insertion of a distal femoral traction pin.
insertion of a reamed antegrade intramedullary nail starting at the piriformis fossa, stopping the nail short of the distal femoral growth plate.
closed reduction and stabilization using retrograde flexible intramedullary nails.
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A 4-year-old girl is involved in a tobogganing accident. She has a fluctuating level of consciousness and requires urgent transport to the local pediatric trauma center. When transporting a pediatric trauma patients, which of the following factors should be considered?
A pelvic binder is required in all pediatric trauma patients
Intraosseous cannulation is the first choice for access in patients with hypovolemia
Modified spinal boards are required for pediatric trauma patients with a suspected spine injury
Intubation is required in pediatric patients when Glosgow Coma Score <12
Nasal cannula airways are required in pediatric patients with head injuries
Which of the following injuries is associated with the highest risk of morbidity and mortality in a pediatric trauma patient?
A 4-year-old child involved in a motor vehicle collision sustains multiple injuries including splenic rupture, bilateral open femur fractures, lumbar burst fracture with compression of the neural elements, and a closed head injury requiring a ventriculostomy. Of these injuries, which is likely to cause the greatest long-term morbidity?
Traumatic brain injury
Peripheral nerve injury
Vertebral column injury
A 5-year-old female presents after being struck by a vehicle in her driveway. She has multiple injuries, including a right femur fracture, and open book pelvis injury, and bilateral clavicle fractures. Peripheral IV access is not able to be obtained in the trauma bay after multiple attempts, and the patients blood pressure is 110/70. Which of the following is the most appropriate method to obtain vascular access in this patient?
Placement of an intraosseous infusion device
Peripherally inserted central catheter (PICC) placement in the upper extremity
Femoral venous cutdown
Subclavian central line placement
Continued attempts at obtaining peripheral IV access
How many milliliters(mL) of intravascular blood volume are present per kilogram of body weight in a healthy 5-year-old child?