The document discusses pediatric trauma, emphasizing its role as a leading cause of death among children, and the importance of prompt and effective treatment. Key aspects include the primary and secondary survey for managing trauma, initial resuscitation priorities, and specific emergency treatments for chest and abdominal injuries, including various diagnostic methods. Furthermore, it highlights the need to recognize patterns of injury that may indicate non-accidental trauma in children.

1. Paediatric Trauma
Dr. Ashok Jaisingani

2. Introduction
► Trauma is leading cause of death in children
and adolescence in western countries.
► Many of these death are avoidable if proper
care and effective treatment is given.

3. Primary Survey
► Approached to the child with major injuries
advocated by “advance trauma life support”
(ATLS), program is essential. Primary survey focus
on
a) Airway
b) Cervical spine
c) Breathing
d) Circulation
e) Control of bleeding
f) Assessment of conscious level,
g) Pupil size & reactivity
h) Rapid overview of all injuries

4. Resuscitation
► Give first priority of treating to life – threatening problems,
identify during primary survey.
► Pt with cardiorespiratory compromise should be provided
with high – flow oxygen
► Endotracheal intubation and ventilation are require if O2 is
inadequate in child with severe head injury or to control
flail chest.
► Pneumothorax & haemothorax are best treated by chest
tube drainage.
► Two large peripheral IV canulae require in severely injured
children.
► Central venous access should only be assess by expert.

5. Resuscitation
► Overextension of the neck during the maintenance of
airway result in respiratory compromisation (short neck
and relatively larger tongue)
► Circulation is evaluated from vital signs, capillary refill time,
skin color, temperature and mental status.
► Systolic BP is normal until 25% of circulatory volume has
been lost.
► Intraosseous vascular assess is helpful in children
► Cervical spine injury can be present without radiological
signs, after major trauma cervical spine injury should be
assumed until it can be excluded by full neurological
assessment, the neck must be immobilized.

6. Secondary Survey & Emergency
Management
► When pt become stable, the secondary
survey attempt to identify all injuries in a
systemic way by detailed clinical
examination and appropriate investigation.
► Emergency treatment involve
1- Treatment of chest injuries
2- Treatment of abdominal injuries.

7. Emergency Treatment Of Chest
Injuries
► Children have relatively elastic ribs, that fracture rarely,
despite that lungs contusion is common without ribs
fracture.
► Major thoracic injuries may coexist despite normal
radiographic findings are
1) Tension pneumothorax
2) Massive Haemothorax
3) Cardiac Temponade
► In all cases airway should be secured, O2 is given and
hypovolemia is corrected with IV – fluid
► Diaphragmatic rupture after blunt abdominal trauma can
be detected by chest x-ray or CT-scan, surgical repair is
undertaken once the pt become stable

8. Emergency Treatment Of Tension
Pneumothorax
► Tension pneumothorax require prompt
clinical diagnosis and immediate needle
thoracocentesis.
► The needle should be inserted via “second
inercostal space”, “midclavicular line”.
► Thoracocentesis is followed by chest tube
drainage.

9. Massive Haemothorax
► Massive haemothorax is treated by chest
tube drainage via “fifth intercostals space
midaxillary line”.

10. Cardiac Temponade
► Cardiac temponade may follow blunt or
penetrating chest injury.
► It require emergency needle
“pericardiocentesis”.

11. Emergency Management Of
Abdominal Trauma
► Blunt abdominal trauma is generally more
common than penetrating injury.
► In children more vulnerable organs are liver and
spleen because less protected by pliable rib cage.
► Intra-abdominal or intra-thoracic bleeding is likely
in shock child with no obvious source of
hemorrhage.
► The abdomen must be carefully inspected for sign
of patterned bruising which indicate forceful
compression against rigid skeleton.

12. Investigations used In Abdominal
Trauma
► The definitive radiological investigation of major
abdominal trauma in haemodynamically stable
child is CT – scan with IV – contrast.
► Expert ultrasound scanning is readily available it
can demonstrate free abdominal fluid and solid
organ injuries but it is not valuable as CT
► Diagnostic peritoneal lavage is obsolete in children
because modern imaging is superior
► Laprotomy is indicated for bowl perforation and
penetrating trauma.

13. Isolated Splenic Or Liver Injury
► Isolated splenic or liver injury can be safely
managed non-operatively in majority of the
child with blunt abdominal trauma.
► Hemorrhage is frequently self limiting, so
that unnecessary surgery and long term risk
of splenectomy can be avoided.

14. Non-operative Management Of
Isolated Splenic or Liver Injuries
► Haemodynamic stability after resuscitation
with fluid not more than 40 – 60 ml/kg.
► Good quality of CT-scan.
► No evidences of hollow visceral injury.
► Frequent careful monitoring and immediate
availability of necessary surgical expertise.

15. Children With Intra-abdominal
Bleeding
► Child with ongoing intra-abdominal bleeding
require laprotomy.
► Preliminary angiography and arterial
embolization can be useful in some cases of
hepatic trauma.
► Bile leak is uncommon and managed with
radiological techniques

16. Accidental Pattern Of Injury
► Pattern of injury often reflect the mechanism as
► Lap belt trauma from motor vehicle crush may
cause injury to duodenum or jejunum and lumbar
spine.
► Bicycle handlebar injuries associated with liver or
pancreatic trauma.
► Straddle injuries may damage urethra and pelvis
► Runover injuries may cause severe crushing of
chest or abdomen.

17. Non-accidental Pattern Of Injury
► Non-accidental injury must considered in following cases
► Multiple injuries at different stage of healing
► Different types of injuries such as
a) Soft Tissues
b) Fracture
c) Burn & Scald
d) Cut and bruise
► Significant delay between injury and seeking medical
advice
► Inconsistent vague history or inappropriate parental
behavior.