Foe education purpose only

1. Assessment and Management
Pediatric Trauma

2. Objectives
 Identify the unique characteristics of the
child as trauma patient, including types of
injury, pattern of injury, anatomic and
physiologic differences in children
compared with adults and long term effects
of injury.
 Describe the primary management of
critical injuries in children, including

3. Airway with cervical spine control
Breathing with recognition and management of immediately
life-threatening chest injuries
Circulation with bleeding control and shock recognition and
management.
Disability with recognition and initial management of altered
mental status and intracranial mass lesions
Exposure with maintenance of body heat
Central nervous system and cervical spine injuries
Chest and Abdominal injuries
Musculoskeletal injuries
Fluid and medication dosages
Psychological and family support

4. Be alert to life-threatening conditions,such as the following:
Life-threatening Conditions
Airway Complete or severe airway obstruction
Breathing Apnea, significant work of breathing, bradypnea
Circulation Absence of detectable pulses, poor
perfusion,hypotension,bradycardia
Disability Unresponsiveness, depressed consciousness
Exposure Significant hypothermia,significant bleeding,petechiae
consistent with septic shock,abdominal distension

5. 1: Support ABC,c (CPR for cardiac arrest)
2: Provide supplementary 100% oxygen
3: Provide assisted ventilation, bag-mask, ET intubation
4: Start cardiac and respiratory monitoring,e.g,ECG,pulse
oximetry, exhaled CO2 if intubated
5: Establish IV/IO access
6: Give a bolus of isotonic crystalloid
7: Obtain laboratory studies such as bedside glucose and
ABG,s
8: Administer drugs
9: Provide electrical therapy
Interventions

6. Most injured children have no hemodynamic
abnormalities BUT “Rapidly Deteriorate’’ and
serious complication develop.
Injury continues to be the most common
cause of death and disability in childhood.
Each year, more than 10 million children in
the United States require emergency
department care for the treatment of injuries.
And each year more than 10,000 children die
from serious injury.

7. Smaller body mass But greater force applied per unit
of body area.
Less fat, less connective tissue, and closer proximity
of multiple organs.
High frequency of multiple injuries seen
Head is proportionately large
•Higher frequency of blunt brain injuries
Unique characteristics of
Pediatric Patients

8. Incompletely calcified, contains multiple active growth
centers and is more pliable,
Internal organ damage is often noted without overlying
bony fracture
Rib fractures in children are uncommon, but pulmonary
contusion is not.
Skull or Rib Fractures
* Massive amount of energy
* Underlying orga injuries, such as traumatic brain and
pulmonary contusion should be suspected.
Skeleton

9. The ratio of a child’s body surface area to body
volume is highest at birth and diminishes as the
child matures.
Thermal energy loss is a significant stress factor.
Long Term Effects
Long term quality of life for children who have
sustained trauma is surprisingly robust
Aggressive resuscitation attempts
Surface Area

10. - It was believe that the chimpanzee version of the immunodeficiency
virus (called simian immunodeficiency virus, or SIV) most likely was
transmitted to humans and mutated into HIV when humans hunted these
chimpanzees for meat and came into contact with their infected blood.
-The earliest known case of infection with HIV-1 in a human was detected in a
blood sample collected in 1959 from a man in Kinshasa, Democratic Republic
of the Congo.

11. Anatomy
Passive flexion of the cervical spine caused by
the large occiput
Plane of the midface be maintained parallel to
the spine board in a neutral position.
Placement of a 1-inch thick layer of padding
beneath the infant’s (<1 year of age) or
toddler’s (1-3 years of age)entire torso
Airway: Evaluation and
Management

12. Transmission

13. * Soft tissues in an infant’s oropharynx
•Relatively large
•* Visualization of the larynx difficult
A child’s larynx is funnel-shaped, allowing
secretions to accumulate in the
oropharyngeal area.
The larynx and vocal cards are more
cephalad and anterior in the neck
Continued:

14. The vocal cords are frequently more
difficult to visualize when the child’s
head in the normal,supine,anatomical
position during intubation than when it
is in the neutral position required for
optimal cervical spine protection.
ETT : depth (cm) = 3x size
Continued:

15. Oral Airway
•Practice of inserting the airway backward
and rotating it 180 degrees is not
recommended
* Trauma with resultant hemorrhage into
soft tissue structures of the oropharynx
Management

16. Orotracheal Intubation
•Cuffed endotracheal tubes
•Size
** Child external nares
** tip of the child’s small finger
*** One size larger and one size smaller
than the predicted size
Management

17. Nasotracheal intubation should not be
performed.
* Blind passage around a relatively acute
angle in the nasopharynx towards the
anterior superiorly located glottis, making
intubation by this route difficult.
Continued:

18. Needle-jet insufflation via the
cricothyroid membrane is an appropriate
temporizing technique for oxygenation,
but it doesn’t provide adequate
ventilation, and progressive hypercarbia
will occur.
Cricothyroidotomy

19. Cricothyroidotomy
Surgical thyroidotomy is rarely indicated
For infants or small children.
Can be performed in older children in
whom the cricothyroid membrane is easily
palpable (usually by the age of 12 years).
Continued

20. Breathing:
Evaluation and
Management

21. Excessive volume or pressure during
assisted ventilation substantially increase
the potential for iatrogenic barotrauma
•** Fragile nature of the immature
tracheobronchial tree and alveoli
Pediatric bag mask < 30 kg
Breathing and Ventilation

22. Evaluation and
Management
Circulation and Shock:

23. A child’s increased physiologic reserve
allows for maintenance of systolic
blood pressure in the normal range,
even in presence of shock.
Recognition of circulatory
compromise

24. * Tachycardia poor skin perfusion
often are only the keys to early
recognition of hypovolemia
* Early assessment by a surgeon
Continued

26. * The high ratio of body surface area to
body mass in children increases heat
exchange with the environment
* Increased metabolic rates, thin skin, and
the lack of substantial subcutaneous tissue.
* Overhead heat lamps, heaters, or thermal
blankets may be necessary.
Thermoregulation

28. Child
Maltreatment