Pediatric Trauma



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


  • 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


Airway

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


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:

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