Essential Paediatric Resuscitation Course

1. Dr Dayang Rafidah binti Awang Habeni
Emergency Physician
Paediatric Resuscitation Course 2021

2.  Epidemiology of paediatric trauma
 Unique anatomic and physiologic
characteristics of children
 Evaluation and management
 Child abuse

3.  Leading cause of death in children and young
adults (49%)
 CNS injury causes most of morbidity
 Increased morbidity with multisystem injury
 Mortality
o 50% at the scene: airway compromise, hypovolemic
shock, CNS injury
o 30% within first few hours of injury: golden hour
o 20% within days/weeks: resulting complications, brain
death
 Blunt trauma more common then penetrating
o Most blunt trauma accidental
o MVA responsible for 75% childhood deaths

5. Anatomical Difference
Shape and Size
 Variable weight and length: one size does not fit all
 Broselow tape
Smaller body mass
 Affect kinetic energy transfer multiorgan trauma
Head proportionately larger
Skeletal growth
 Incomplete calcifications, active growth centers, elasticity
 Higher frequency of incomplete fractures/ disturbances to growth
Surface area
 Ratio body surface to volume diminished: thermal loss
 Temperature regulation matures by age 10 yrs

6.  More anterior placed
 Smaller overall diameter with
larger tongues
 Shorter trachea - risk mainstem
intubation / dislodged tube
 Smaller, narrower funneled shaped
 Epiglottis changes from U shaped
to thinner adult structure; drops
from level of C1 to C3

7. Poor compensation for associated respiratory
derangements
 Larger oxygen consumption
 Smaller functional residual capacity
 Less pulmonary compliance/ greater chest wall
compliance
 Horizontally aligned ribs - diaphragm breathers

8.  Variable HR, RR, BP
 Infants dependent on HR for compensation/
cardiac output
 Compensatory vasoconstriction: normal BP
with early shock
 Shock : late identification

12.  Airway management
sequence
● Jaw thrust
● Suction/removal of foreign
body under direct vision
● Oro‐/nasopharyngeal
airways
● Tracheal intubation
● Surgical airway

13.  Effort, Efficacy, Effect
 Look, Listen, Feel

15.  Shock major concern: often missed in early stages
 Normal blood volume: 70 - 80ml/kg
 May not see hypotension until loss of 30% blood
volume10
o 15%: mild tachycardia
o 30%: tachycardia, diminished peripheral pulses
o 30-45%: decreased urine output, thready central
pulses, narrow pulse pressure
o >45%: coma

16.  Assessment: signs of shock
o Heart rate: tachycardic
o Pulses: loss of peripheral pulses, narrow pulse
pressure,
o Loss of central pulse - you are too late
o Blood pressure:
Lower limits systolic: 65+(2 x age in years)

17.  Basic steps to
management
o Vascular access:
essential in all
patients
 Large bore peripheral
catheter: ideally two
sites of access
o Failed 2 attempts IV
access - Intraosseous
placement
o Central access
• Anteromedial tibia
2-3cm below tibial
tuberosity
• Distal tibia:
proximal to medial
malleolus
• Distal femur –
anterolateral
surface, 3 cm
above lateral
condyle

19.  Use of tranexamic acid (dose 15 mg/kg)
 Effective use of adjuncts (e.g. tourniquets, pelvic
splints)
 Implementation of massive haemorrhage protocols
(MHP)
 Avoidance of hypothermia using airflow heating
devices
 by use of optimal ratios of red cells to other blood
products
 Prompt restoration of perfusion after controlling
haemorrhage (monitored by the lactate level
returning to normal within a few hours)
 Damage control interventions, involving surgery and
interventional radiology

20. Abbreviated neurologic exam
 Cognitive
o GCS
o AVPU
 Pupils
o Early sign of developing increased intracranial
pressure
o Asymmetry
 Motor
o Early detection spinal cord injury

22.  Suspect child abuse:
o Inconsistent history
o Prolonged interval between time of injury and
presentation to medical care
o Repeated trauma
o History of “doctor shopping”
o Mechanism of injury not appropriate based on
child’s developmental age

23.  Physical signs
 Multiple subdural hematomas, especially
without a fresh skull fracture
 Retinal hemorrhages
 Bizarre injuries, such as bites, cigarette
burns, or rope marks
 Sharply demarcated second- and third-
degree burns
 Skull fractures or rib fractures seen in
children less than 24 months old

24.  Multicolored bruises (bruises in
different stages of healing)
 Evidence of frequent previous
injuries, typified by old scars or
healed fractures on x-ray
examination
 Perioral injuries
 Injuries to the genital or perianal
area
 Fractures of long bones in
children younger than 3 years of
age
 Ruptured internal viscera without
antecedent major blunt trauma

25.  Unique characteristics of children include important
differences in anatomy, body surface area, chest
wall compliance, and skeletal maturity
 Normal vital signs vary significantly with age
 Initial assessment and management of severely
injured children is guided by the ABCDE approach.
Early involvement of a general surgeon or pediatric
surgeon is imperative in the management of injuries
in a child
 Child maltreatment should be suspected if
suggested by suspicious findings on history or
physical examination.

26. 1. Advanced Paediatric Life Support The Practical
Approach Manual (5th Edition). Wiley-Blackwell
2. Advanced Trauma Life Support Manual (9th
Edition)
3. Tintinalli’s Emergency Medicine. A
comprehensive Study Guide(7th edition)