Professional Documents
Culture Documents
PADA ANAK
Achmad Yani ,MD
Division of Pediatric Surgery
Ciptomangunkusumo Hospital
Kegawatan Bedah Anak
} TRAUMA
} NON TRAUMA
Key differences:
Larger surface area to mass ratio
Less SQ fat
More body water
Higher metabolic rate
FLUID BALANCE
} Maintenance Fluid Requirement:
} 0 10 Kg ---> 4 ml/Kg/hr
} 10 20 Kg ---> 2ml/Kg/hr + 40 ml
} Ongoing losses
Abdominal Pain Assessment:
q Colicky pain Intermitten
q Ischemia Pain
q Inflamation Pain
} Nausea/vomiting/diarrhea
} aches/pains
} crampy vs steady
} urinary symptoms
Physical
} Vitals, % Dehydration, position of child
} local findings
} Inguinoscrotal exam
Abdominal Pain Assessment:
q Lab Data
} CBC
} Urine
q Abdominal X-ray
} AXR
} CXR
} Selected contrast studies
q Ultrasound
q CT scan
Working diagnosis by site
of pain:
GER
Gastritis
Cholelithiasis
PUD
Gallbladder
dyskinesia
Pancreatitis
Appendicitis
Henoch-Schnlein
Mesenteric adenitis
Meckel diverticulitis
Obstruction
Ovarian torsion
Constipation
UTI
Inguinal-scrotal Ovarian torsion
mass
BOWEL OBSTRUCTION:
Key Features
} Previous surgery
} Age of the child
Contra Indication
Abdominal X-rays
Contrast studies
Ultrasound
INTUSSUSCEPTION
INTUSSUSCEPTION
} Age 2 months to 2 years
} Usually have or had a recent viral illness
} C = Cardiac
} T = Tracheal (TEF)
} E = Esophageal (TEF)
} R = Renal (absent kidney, etc)
} L = Limb (radial anomalies)
Newborn with vomiting
Small Bowel Atresia
Hirschsprungs Disease
} Congenital absence
of Ganglion cells
} In 90% of cases the
transition between
abnormal and
normal bowel is the
rectosigmoid
junction
} Present with failure
to pass meconium
and a distal bowel
Imperforate Anus
} High IA =
colostomy and then
definitive repair
later
} Low IA = anal repair
shortly after birth
} Look for the
VACTERL
associations
Gastroschisis
} Herniation of the
bowel out a small
defect near the
umbilicus. No
covering sac.
} Bowel can be quite
damaged.
} These infants
usually do not have
other congenital
anomalies (good
Omphalocele
} Central abdominal
wall defect. Has a
covering sac.
} Associated with
other congenital
anomalies (bad
baby good bowel)
} Repair primarily or
use a staged
silotechnique
Hernia or Hydrocele?
Hernia or Hydrocele?
Umbilical Hernia
} 90 95% will resolve
spontaneously
} Rarely, if ever,
cause symptoms
} Recommend
surgical repair after
3 to 5 years of age
Pediatric Trauma
Anatomic/Physiologic Issues
q Airway
} Large head and tongue
} Larger U shaped epiglottis
} C-spine -SCIWORA
Pediatric Trauma -
Airway Management
q Oral Airway
q OrotrachealIntubation
q Cricothyroidotomy
} Surgical
} Needle
Pediatric Trauma -
Breathing -Issues and Management
} 20 ml/kg X 3
} then 10ml/kg PRBC typed, type specific, O
neg
} if hypotensivego straight to PRBC once
available
Pediatric Trauma -
Circulation/Shock
q Venous Access
} peripheral IV access two attempts (5 minutes)
} interosseous -tibia or distal femur
34
Pediatric Trauma -
Chest Trauma
q Increase mediastinalmobility
q Thoracotomy-rarely needed
Pediatric Trauma -
Abdominal Trauma
} Assessment difficult
} Gastric distension -NG/OG tube
} Bladder distension -urinary catheter
q Pancreatic Injury
q Lap Belt Injury