Pediatric Trauma

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Pediatric Trauma
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Trauma

• 1 killer of children after neonatal period
• 50 of childhood deaths

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Pediatric Trauma

• Same priorities as adults
• ABCs first

Children are not just little adults!
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Airway

• Anatomy increases obstruction risk
• Large head
• Short neck
• Small mandible
• Large, posteriorly-placed tongue

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Airway

• Poor, absent mouth breathing ability
• Neck over-extension obstruction secondary to
  high glottis
• Good anterior jaw displacement important

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Airway

• ET tubes wind up in right mainstem
• Secure intubated childs head in neutral
  position avoid extubation
• Pass gastric tube early decompress stomach

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Breathing

• Increased respiratory rate
• 30/min ? normal for small child
• Slowing rate impending arrest

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Breathing

• Small thorax
• Transmitted breath sounds
• Misleading findings on auscultation
• Inspection, palpation more reliable

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Breathing

• Diaphragm breathers
• Pliant chest walls
• Weak accessory muscles
• Limited respiratory reserve

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Breathing

• Respiratory Failure Leading Cause of
  Pediatric Cardiac Arrest

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Circulation

• Small blood volume
• Rapid control of blood loss essential
• Good initial compensation for hypovolemia
• Sudden onset of irreversible shock

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Circulation

• BP monitoring
• Poor method
• To assess perfusion, check
• Rate, quality of peripheral pulses
• Skin color, temperature
• Capillary refill
• Level of consciousness

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Circulation

• Silence is not Golden

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Shock Management

• 100 Oxygen
• Assist ventilation as needed
• Keep warm
• MAST
• Legs only initially
• If abdomen needed, intubate/ventilate

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Shock Management

• Fluid Resuscitation
• LR in 20cc/kg boluses
• Reassess, reassess, reassess
• Repeat boluses as indicated by response
• Warm fluids if possible
• Gastric tube placement

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Head Trauma

• Major cause of pediatric trauma deaths
• Intracranial hematomas less common
• Diffuse axonal injury, edema more common
• Outcomes better than in comparably injured adults
• Treat aggressively

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Head Trauma

• Evaluate for increased ICP
• AVPU
• Pupils
• Vomiting
• Dysconjugate eye movement
• Cushings response

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Head Trauma

• Control airway
• Protect cervical spine
• Controlled hyperventilation (10 breaths/min above
  normal)
• Ensure adequate shock resuscitation

Isolated head injury usually does not cause
shock!!
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Spinal Trauma

• Rare in pediatric patients
• Usually high C-spine dislocation
• C-1, C-2

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Spinal Trauma

• Suspect in same situations as adult
• Sudden deceleration
• Head, face injuries
• Decreased LOC in trauma
• Absence of good history

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Spinal Trauma

• If you think about spinal immobilization, do it!!
• Resist temptation to pick up child, run

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Chest Trauma

• Second leading cause of death after head trauma
• Primarily blunt
• High incidence of associated head, extremity
  injury

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Chest Trauma

• Pediatric thoracic wall pliant
• Rib fracture, flail chest rare
• Severe intrathoracic trauma can occur without
  fracture

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Chest Trauma

• Limited respiratory reserve
• Trauma poorly tolerated
• Recognize, intervene early

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Abdominal Trauma

• Most common form
• Primarily blunt
• Spleen, liver Most common injuries
• High, broad costal arch
• Relatively larger organs
• Poor abdominal muscle development

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Abdominal Trauma

• Mechanism of injury
• Unexplained hypovolemic shock
• Tenderness
• Increased abdominal girth
• Intra-abdominal hemorrhage until proven otherwise
• Could be gastric distension

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Extremity Trauma

• Never warrants attention before head, chest,
  abdomen injury

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Extremity Trauma

• Most common complication neurovascular injury
• Especially common in supracondylar areas of
  humerus, femur

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Extremity Trauma

• Evaluate distal extremity for
• Pulses
• Skin color, temperature
• Motor, sensory function
• Capillary refill

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Extremity Trauma

• Unique injuries
• Greenstick fracture
• Tenderness, edema, guarding, inconsolable crying
  fracture until proven otherwise
• Epiphyseal plate fracture
• Injuries near bone ends
• ? Growth problems

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Burns

• Pediatric patients
• 50 of burn admissions
• 33 of burn deaths

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Burns

• Large body surface area increased
• Fluid loss
• Heat loss

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Burns

• Immature immune system
• Increased infection complications
• Small airways
• Decreased respiratory reserve
• Increased complications of airway burns

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Burns

• Pediatric Burns
• Possible Child Abuse