Pediatric Trauma

Angelo Mikrogianakis

Introduction

Leading cause of death and disability in children
Compromise of oxygenation and ventilation is common
Compromise of perfusion is less common but potentially lethal
Major causes of death are airway compromise and inadequate volume resuscitation
Blunt trauma more common than penetrating injury
- Head injury 55%
- Internal injuries 15%

Initial management is divided into four phases:

Primary Survey

Follow Advanced Trauma Life Support primary assessment algorithm:

A Airway maintenance with C-spine protection

B Breathing and ventilation

C Circulation with hemorrhage control

D Disability (neurologic status)

E Exposure and environmental control

Airway

Assess and support the airway while immobilizing the cervical spine if needed:

Breathing

Identify causes of respiratory failure:

Hypoventilation due to brain injury
Pneumothorax or tension pneumothorax
Hemothorax
Flail chest
Pulmonary contusion
Most thoracic injuries can be diagnosed by history, examination, and chest X-ray
Open pneumothorax

Circulation

Identify signs of shock, determine cause, and implement treatment:

Assess for hemorrhage: assess for active external bleeding and internal bleeding (such as occurs after solid organ injury)
Establish vascular access with two large-bore IVs and provide volume resuscitation
Identify hemodynamic instability, which may persist despite volume resuscitation: consider occult blood loss and spinal shock
Prevent or promptly treat potential causes of secondary brain injury, including hypovolemia, hypotension, and hypoxia

Disability

Perform a rapid neurologic assessment to identify conditions that require urgent intervention: