1

ACS

Pediatric Trauma
2
ACS

Objectives

 Identify unique characteristics of

children.
 Discuss and demonstrate primary
management of pediatric trauma.
 Identify injury patterns of child abuse.
3
ACS

Special Considerations
 Size and shape
 Skeleton
 Surface area
 Psychologic status
 Long-term effects
 Equipment
4
ACS

Airway

Anatomy
 Craniofacial disproportion
 Large occiput → cervical flexion
 Infants : Obligate nasal breathers
 Larynx : Anterior caudad angle
 Trachea : Short
5
ACS

Airway
Management
 Head : Sniffing position
 Suction, oxygenate, ventilate
 Endotracheal intubation
 Needle cricothyroidotomy
6
ACS

Rapid Sequence Intubation

Preoxygenate

Sedation / Atropine

Hypovolemic Normovolemic
(Midazolam*) (Thiopental*)

Cricoid Pressure

Paralysis*
(Succinylcholine)

*Caution Intubate, Check Tube Position

7
ACS

Breathing / Ventilation
Assessment and Management
 Rate
 Tidal volume
 Pressure
 Caution : Hypoventilation
 Tube thoracostomy
8
ACS

Hemodynamic Changes
9
ACS

Shock Management
Fluid Resucitation
 Blood volume = 80 mL/kg
 Bolus : 20 mL/kg warmed Ringer’s lactate
solution (may repeat x 2)
 Consider PRBCs with 3rd fluid bolus
 Temperature regulation
10
ACS

Shock Management
Responses to Treatment
Usual Common Rare

Crystalloid Crystalloids Crystalloids

bolus + PRBCs + PRBCs,
↓ ↓ If no ∆
Normal Normal ↓
↓ ↓ Operation
No operation No operation
11
ACS

Shock Management

Blood Replacement
 10 ml/kg PRBCs
 Type –specific or O-negative
 Warmed
 Immediate surgical consult!
12
ACS

Shock Management
Venous Access
 Percutaneous peripheral
 Intraosseous : ≤ 6 years
 Cutdown : Saphenous at ankle / groin
 Special lines
13
ACS

Chest Trauma
 Rib fracture : Severe injuring force
 Compilant chest wall : Lung contusion
 Mediastinal mobility :↑sensitivity to
pulmonary injury
 Thoracotomy : Usually not needed
 Other organ system injuries
14
ACS

Abdominal Trauma
 Method of assessment
 Gastric distention
 Urinary catheter
 Diagnostic adjuncts
• CT with contrast

• DPL / Ultrasonography
15
ACS

Abdominal Trauma

Management

Nonoperative Operation

Decision by Surgeon
16
ACS

Head Trauma
Differences
 Anatomic : fontanelles, suture lines
 Outcome
 Extracranial injuries
 Hypotension Management
 Secondary brain injury same as
adult
17
ACS

Head Trauma
Pediatric Verbal Response Score
Appropriate words, 5
response 4
Cries but consolable 3
Persistently irritable 2
Restless, agitated 1
None

(Pediatric Modification of GCS for verbal)

18
ACS

Spinal Cord Injury

 Differences
• Interspinous ligaments, joint capsules

• Vertebrae, wedged anteriorly

• Flat facets

• Larger head

 X-ray considerations
 Treatment
19
ACS

Musculoskeletal Trauma

 Management principles same

 History important
 Growth plate frequently involved
 Blood loss proportionately greater
 Unique fractures
20
ACS

Child Abuse
 History
 Injury patterns
21
ACS

Questions

?
22
ACS

Summary

 Same management principles as for adults

 Unique anatomic and physiologic
differences
 Involve surgeon early !