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:
Apply AVPU Pediatric Response Scale
Alert
Verbal—responsive to verbal stimuli
Painful—responsive to painful stimuliRelated posts:
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