Pediatric Trauma

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Information about Pediatric Trauma

Published on October 16, 2008

Author: aSGuest1140


Pediatric Trauma : Pediatric Trauma Trauma : Trauma #1 killer of children after neonatal period 50% of childhood deaths Pediatric Trauma : Pediatric Trauma Same priorities as adults ABC’s first Children are not just little adults! Airway : Airway Anatomy increases obstruction risk Large head Short neck Small mandible Large, posteriorly-placed tongue Airway : Airway Poor, absent mouth breathing ability Neck over-extension: obstruction secondary to high glottis Good anterior jaw displacement important Airway : Airway ET tubes wind up in right mainstem Secure intubated child’s head in neutral position; avoid extubation Pass gastric tube early; decompress stomach Breathing : Breathing Increased respiratory rate 30/min = ? normal for small child Slowing rate = impending arrest Breathing : Breathing Small thorax Transmitted breath sounds Misleading findings on auscultation Inspection, palpation more reliable Breathing : Breathing Diaphragm breathers Pliant chest walls Weak accessory muscles Limited respiratory reserve Breathing : Breathing Respiratory Failure Leading Cause of Pediatric Cardiac Arrest Circulation : Circulation Small blood volume Rapid control of blood loss essential Good initial compensation for hypovolemia “Sudden” onset of irreversible shock Circulation : Circulation BP monitoring Poor method To assess perfusion, check: Rate, quality of peripheral pulses Skin color, temperature Capillary refill Level of consciousness Circulation : Circulation Silence is not Golden Shock Management : Shock Management 100% Oxygen Assist ventilation as needed Keep warm MAST Legs only initially If abdomen needed, intubate/ventilate Shock Management : 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 Head Trauma : 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 Head Trauma : Head Trauma Evaluate for increased ICP AVPU Pupils Vomiting Dysconjugate eye movement Cushing’s response Head Trauma : 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!! Spinal Trauma : Spinal Trauma Rare in pediatric patients Usually high C-spine dislocation C-1, C-2 Spinal Trauma : Spinal Trauma Suspect in same situations as adult Sudden deceleration Head, face injuries Decreased LOC in trauma Absence of good history Spinal Trauma : Spinal Trauma If you think about spinal immobilization, do it!! Resist temptation to pick up child, run Chest Trauma : Chest Trauma Second leading cause of death after head trauma Primarily blunt High incidence of associated head, extremity injury Chest Trauma : Chest Trauma Pediatric thoracic wall pliant Rib fracture, flail chest rare Severe intrathoracic trauma can occur without fracture Chest Trauma : Chest Trauma Limited respiratory reserve Trauma poorly tolerated Recognize, intervene early Abdominal Trauma : Abdominal Trauma Most common form Primarily blunt Spleen, liver = Most common injuries High, broad costal arch Relatively larger organs Poor abdominal muscle development Abdominal Trauma : Abdominal Trauma Mechanism of injury Unexplained hypovolemic shock Tenderness Increased abdominal girth Intra-abdominal hemorrhage until proven otherwise Could be gastric distension Extremity Trauma : Extremity Trauma Never warrants attention before head, chest, abdomen injury Extremity Trauma : Extremity Trauma Most common complication = neurovascular injury Especially common in supracondylar areas of humerus, femur Extremity Trauma : Extremity Trauma Evaluate distal extremity for: Pulses Skin color, temperature Motor, sensory function Capillary refill Extremity Trauma : Extremity Trauma Unique injuries Greenstick fracture Tenderness, edema, guarding, inconsolable crying = fracture until proven otherwise Epiphyseal plate fracture Injuries near bone ends ? Growth problems Burns : Burns Pediatric patients 50% of burn admissions 33% of burn deaths Burns : Burns Large body surface area increased Fluid loss Heat loss Burns : Burns Immature immune system Increased infection complications Small airways Decreased respiratory reserve Increased complications of airway burns Burns : Burns Pediatric Burns Possible Child Abuse

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