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Pediatric Trauma
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Objectives

Identify unique characteristics of

children.
Discuss and demonstrate primary
management of pediatric trauma.
Identify injury patterns of child abuse.
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Special Considerations
Size and shape
Skeleton
Surface area
Psychologic status
Long-term effects
Equipment
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Airway

Anatomy
Craniofacial disproportion
Large occiput cervical flexion
Infants : Obligate nasal breathers
Larynx : Anterior caudad angle
Trachea : Short
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Airway
Management
Head : Sniffing position
Suction, oxygenate, ventilate
Endotracheal intubation
Needle cricothyroidotomy
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Rapid Sequence Intubation

Preoxygenate

Sedation / Atropine

Hypovolemic Normovolemic
(Midazolam*) (Thiopental*)

Cricoid Pressure

Paralysis*
(Succinylcholine)

*Caution Intubate, Check Tube Position

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Breathing / Ventilation
Assessment and Management
Rate
Tidal volume
Pressure
Caution : Hypoventilation
Tube thoracostomy
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Hemodynamic Changes
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Shock Management
Fluid Resucitation
Blood volume = 80 mL/kg
Bolus : 20 mL/kg warmed Ringers lactate
solution (may repeat x 2)
Consider PRBCs with 3rd fluid bolus
Temperature regulation
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Shock Management
Responses to Treatment
Usual Common Rare

Crystalloid Crystalloids Crystalloids

bolus + PRBCs + PRBCs,
If no
Normal Normal
Operation
No operation No operation
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Shock Management

Blood Replacement
10 ml/kg PRBCs
Type specific or O-negative
Warmed
Immediate surgical consult!
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Shock Management
Venous Access
Percutaneous peripheral
Intraosseous : 6 years
Cutdown : Saphenous at ankle / groin
Special lines
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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
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Abdominal Trauma
Method of assessment
Gastric distention
Urinary catheter
Diagnostic adjuncts
CT with contrast

DPL / Ultrasonography
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Abdominal Trauma

Management

Nonoperative Operation

Decision by Surgeon
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Head Trauma
Differences
Anatomic : fontanelles, suture lines
Outcome
Extracranial injuries
Hypotension Management
Secondary brain injury same as adult
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Head Trauma
Pediatric Verbal Response Score
Appropriate words, response 5
Cries but consolable 4
Persistently irritable 3
Restless, agitated 2
None 1

(Pediatric Modification of GCS for verbal)

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Spinal Cord Injury

Differences
Interspinous ligaments, joint capsules

Vertebrae, wedged anteriorly

Flat facets

Larger head

X-ray considerations
Treatment
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Musculoskeletal Trauma

Management principles same

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

Child Abuse
History
Injury patterns
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Questions
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Summary

Same management principles as for adults

Unique anatomic and physiologic
differences
Involve surgeon early !