Pediatric Trauma

Pediatric Trauma

Angelo Mikrogianakis


  • 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

  • Initial resuscitation

  • Secondary survey

  • Definitive treatment

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


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

  • Use a jaw thrust without head tilt if suspect cervical spine injury

  • Have suction available at all times

  • Determine need for advanced airway adjuncts (intubation)

  • Treat hypoxia to prevent secondary hypoxic brain injury

  • Specific indications for intubation:

    • Inability to protect airway

    • Need for positive pressure ventilation

    • Airway burn or inhalational injury

    • Severe head injury GCS < 8

    • Major maxillofacial trauma


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


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


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

Jun 22, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Pediatric Trauma
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