What Is Pediatric Trauma Nursing?

The typical symptom of simple spleen rupture is that the child cannot immediately stand upright after being directly hit or severely injured in the left upper abdomen, especially the left abdominal flexion. Can't even stand up, lying down, leaning to the left and bending forward, afraid to move. Soon abdominal pain, bloating, poor mentality, and refusal to eat. In severe cases, pale symptoms, cold sweats, irritability, and other pre-shock symptoms.

Spleen trauma in children

Due to trauma, the spleen is severely vibrated and ruptured or torn, causing internal bleeding. Spleen trauma is one of the common clinical emergencies. Failure to receive timely treatment often results in shock and death.

Pediatric spleen trauma symptoms and signs

There was tenderness on palpation of left upper abdomen, dullness on percussion. The diagnosis of celiac puncture as bloody abdomen is basically confirmed. If the condition of the child is allowed to move, a B-ultrasound can show the appearance of the spleen and the fissure, and can estimate the amount of bleeding and the formation of hematomas. It is an important diagnostic method before surgery if necessary. The blood image was basically normal in the early stage, and obvious anemia was seen after more than ten hours.

Because the spleen rupture is part of a complex injury such as a fall or a bump, a comprehensive systemic examination must be performed on each child, including facial features, neck movements, chest auscultation, limb spine, and hematuria. Observe for 6h. If necessary, X-rays, CT, MRI and other tests are performed to strive for safe and rapid diagnosis.

If natural spleen rupture or pathological spleen rupture is considered, the cause of splenomegaly needs to be further diagnosed in order to cure radically after hemostasis.

Laparoscopy has little effect in the diagnosis and treatment of spleen rupture. Only when the blood volume is not large, and the abdominal signs do not progress after 3 days of observation, it can be used instead of laparotomy.

Pediatric spleen trauma medication

Because the spleen rupture is mainly due to hemorrhagic shock, the primary goal of treatment is to rescue or prevent shock and quickly stop bleeding. Traditionally recognized as the fastest and most reliable measure is immediate emergency splenectomy. In recent years, the incidence of fulminant infections after splenectomy in children is relatively high, and many children with splenic rupture can be observed to stop bleeding naturally. Conventional splenectomy therapy has been greatly restricted in the past.

1. Principles of treatment of spleen rupture in children

(1) Clinical shock (no blood pressure, semi-coma) was present at the time of consultation: rapid blood transfusion and infusion totaled 60ml / kg, blood pressure could not be recovered within 20min, and repeated 60ml / kg immediately. Still not recovering or cannot maintain stability for 2 hours after blood pressure rises, surgery should be performed while blood transfusion is performed, and bleeding should be stopped immediately.

(2) Pre-shock at the time of consultation: Children with blood pressure, fast pulses, and irritability should be given rapid blood transfusions and infusions above 60ml / kg. If the situation does not improve, immediately stop bleeding.

(3) Blood pressure and pulse are normal at the time of consultation: Blood pressure and pulse are normal at the time of consultation, and the spirit is quiet. The condition of blood transfusion 60ml / kg is stable, then continue observation. Sudden blood pressure drops at any time, and immediate operation to detect hemostasis.

2. Observation and non-surgical treatments include absolute bed rest, fasting gastrointestinal decompression, giving sedatives to make children sleep well, keeping veins open, infusion to maintain nutrition, and giving hemostatic agents and antibiotics. Blood transfusion should be based on hemoglobin level, generally maintained at 90 ~ 120g / L. After 24 hours, the spirit was normal, the appetite was good, the abdominal tenderness was reduced, and there was no bloating. Should stay in bed for 1 week strictly, abdominal signs disappeared, and blood was normal before returning to diet and activities. During the observation period, blood pressure should be measured every hour, and hemoglobin should be checked every 6 hours until it is stable for 48 hours. Blood pressure drops at any time. Immediate rapid infusion, blood transfusion of 60ml / kg, can not restore stability, and immediately prepare for surgery.

3. Hemostasis in surgery For acute major hemorrhage, rapid splenectomy (grabbing method) should be used for rescue shock. Grasp the spleen immediately, close the spleen with spleen pedicle forceps or right-angle forceps, suck up the accumulated blood, and then carefully separate the spleen hilum, ligate blood vessels if necessary, and perform splenectomy. If the rupture is not serious and the bleeding is not serious, the spleen membrane should be sutured as far as possible to prevent bleeding through preparations such as absorbent gelatin sponge, hemostatic yarn and thrombin. For comminuted spleen rupture, the spleen can be wrapped with an absorbable spleen net (we can use the white intestine line) to tighten and pressurize the hemostasis to strengthen the hemostatic yarn. Partial splenectomy is also possible depending on the rupture. Ruptured splenic pedicles had to be removed. However, after the splenectomy, the intact part can be washed with saline, cut into (1 ~ 2cm) × (1 ~ 2cm) × (1 ~ 2mm) slices and transplanted into the omentum, and can also retain immunity effect. It is best to keep 1/3 of the spleen as much as possible.

When the liver, kidney, pancreas and peritoneum are probed at the same time during surgery, sutures are usually used to stop bleeding. The abdomen should be drained.

Pediatric spleen trauma diet health

There is a kind of snack in Chaoshan, Chaozhou. Guangzhou people call it "Shahe Fan", Chaoshan people call it "Cooking ", " ", " ".

Preventive care of spleen trauma in children

Strengthen care to prevent various injuries and accidents.

Pathological etiology of spleen trauma in children

It is more common in abdominal blunt injuries or falls and collisions. Most of them are indirect vibration injuries, and rarely direct injuries. It is often part of a serious closed injury such as a fall, a collision, or a car accident. Therefore, it is possible to diagnose severe and obvious trauma such as a head injury, multiple fractures, etc., and ignore the spleen rupture, or diagnose a spleen rupture, and ignore other organ damage. The spleen is a parenchymal organ with a high tension of the capsule and a brittle texture. It is a fixed organ in the abdomen, but it has a certain degree of activity and is easily ruptured or torn by strong vibration. The normal spleen is not easy to be injured under the protection of the left quarter rib, but it is still the most easily ruptured organ in the abdomen under severe earthquake injury. If the spleen is large and diseased, especially the congested spleen, it is more likely to rupture when exposed to the quarter ribs. Abdominal blunt contusions and severe fall injuries have led to the highest incidence of splenic ruptures. It often coexists with liver rupture. The enlarged spleen is more likely to rupture due to disease. It can be ruptured due to inadvertent minor injury, which is called "natural spleen rupture."

Diagnosis of spleen trauma in children

Often co-existing with liver rupture, or previous spleen enlargement, care should be taken to identify whether spleen rupture is associated.

Pediatric spleen trauma examination method

Laboratory inspection:

Peripheral red blood cell count and hemoglobin volume decreased progressively.

Other auxiliary checks:

Abdominal ultrasound examination should be done, if necessary, X-ray, CT, MRI and other examinations.

Complications of spleen trauma in children

Shock and even death are often caused by heavy bleeding. Rupture of the spleen is often part of a complex injury.

Prognosis of spleen trauma in children

Spleen trauma alone is rarely fatal. Fewer than 25% of patients need surgical exploration, and splenectomy is rare. Large pathological spleen should still undergo preventive splenectomy.

Pathogenesis of spleen trauma in children

Due to the high tension of the splenic membrane, it is not easy to gather after rupture, so it is easy to stop bleeding. Internal bleeding is a prominent pathology, often caused by shock due to heavy bleeding. Due to the thin spleen capsule and the lack of connective tissue around the spleen, after the rupture, blood flows into the free abdominal cavity, and blood clots are rarely retained at the break and the adhesions heal. Even if the blood is temporarily stopped, the possibility of rebleeding is greater.