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International Trauma Life Support for Emergency Care Providers CHAPTER seventh edition Trauma in Children 17.

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Presentation on theme: "International Trauma Life Support for Emergency Care Providers CHAPTER seventh edition Trauma in Children 17."— Presentation transcript:

1 International Trauma Life Support for Emergency Care Providers CHAPTER seventh edition Trauma in Children 17

2 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Trauma in Children © Pearson

3 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Overview Effective techniques to gain confidence Injuries based on mechanisms of injury ITLS Primary and Secondary Surveys Consent and the need for immediate transport

4 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Overview Pediatric equipment needs Various methods of SMR on children EMS involvement in prevention programs

5 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Trauma in Children Different from adults –Anatomical differences  Different patterns of injuries  Different responses to those injuries  Special equipment required –Assessment equipment and treatment equipment –Difficult to assess and communicate –Come with parents and other family members

6 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Communicating Family-centered care is critical –Caregiver not always parent –Involve parent as much as possible in care –Give explanations and careful instructions –Inclusion and respect will improve stabilization –Keep parents in physical and verbal contact Demonstrate competence and compassion

7 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Assessing Mental Status Consoled or distracted –Most sensitive indicator of adequate perfusion –Parents best at detecting subtle changes Initial level of consciousness –Preschool child: sleeping vs. unconscious  Most will not sleep through arrival of ambulance  Ask parents to wake child  Suspect hypoxia, shock, head trauma, seizure

8 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Communicating Interaction strategies –Appropriate language for developmental level –Speak simply, slowly, clearly  Be gentle and firm –Avoid “no” questions –Get a favorite belonging –Get on child's level –Explain SMR necessity –Allow parent to accompany child © Pearson

9 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Parental Consent Critical care should not be delayed. Emergency care needed –Consent not available  Transport before permission, document why, notify medical direction –Consent denied  Try to persuade, document actions, obtain signature  Notify law enforcement and appropriate authorities  Report suspected abuse

10 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Pediatric Equipment Length-based tape –Weight estimate –Fluid and medication doses precalculated –Common equipment size estimates Courtesy of James Broselow, MD Photos courtesy of Kyee Han, MD Courtesy of Louis B. Mallory, MBA, REMT-P

11 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Mechanisms of Injury Falls –Usually land on head –Serious head injury unusual from <3 feet (1 meter) –Protective gear MVCs –Seat-belt syndrome  Liver, spleen, intestines, lumbar spine Auto-pedestrian crashes

12 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians General Assessment (Copyright American Academy of Pediatrics. Used with permission.)

13 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Airway Assessment Opening airway –Tongue is large; tissue soft  Jaw-thrust  Oropharyngeal airway  Nasopharyngeal airways –Too small to work predictably –Neonate obligate nose breather  Clear nose with bulb syringe Courtesy of Louis B. Mallory, MBA, REMT-P

14 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Airway Assessment Signs of obstruction –Apnea –Stridor –“Gurgling” respiration Contribute to obstruction –Hyperextension –Hyperflexion Courtesy of Bob Page, NREMT-P © Pearson

15 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Breathing Assessment Work of breathing –Retractions, flaring, grunting  Persistent grunting requires ventilation Respiratory rate –Fast, then periods of apnea or very slow Minor blunt neck trauma can be critical

16 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Ventilation Give ventilations slowly Lowest pressure necessary 20, 15, 10 –20 bpm < 1 year old –15 bpm > 1 year old –10 bpm adolescent

17 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Breathing Management Effective BVM ventilation— intubation is elective. Effective BVM ventilation— intubation is elective. Courtesy of Louis B. Mallory, MBA, REMT-P

18 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Endotracheal Intubation Oral endotracheal intubation –No blind nasotracheal intubation for <8 years Uncuffed tube –Length-based tape system –Same diameter as tip of child's little finger – –Frequently reassess placement –Alternative airways 4 + age in years = size of tube (mm) 4

19 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Circulation Assessment Early shock more difficult to determine –Persistent tachycardia  Rate >130 usually shock in all ages except neonates –Prolonged capillary refill and cool extremities –Level of consciousness  Circulation can be poor even if child is awake –Low blood pressure is sign of late shock  BP <80 mmHg in child; <70 mmHg in young infant

20 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Bleeding Control immediately –Avoid large bulky dressings –Constant direct pressure –Hemostatic agents –Tourniquets with caution Blood volume mL/kg –Example: 200-mL loss is approximately 20% in a 10 kg child

21 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Critical Trauma Situation Perform only necessary procedures –Control bleeding –SMR –Oxygenation –Ventilation Rapid, safe transport –Appropriate destination

22 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Hemorrhagic Shock Strong compensatory mechanisms –Appear surprisingly good in early shock –“Crash” when deteriorate –Be prepared –Fluid administration 20 mL/kg in each bolus  Consider intraosseous infusion –Frequent Ongoing Exams

23 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Life-Threatening Injuries Head injury –Most common cause of death  Level of consciousness change best indicator  Pupil assessment important

24 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Life-Threatening Injuries Head injury –Treatment  High-flow oxygen  Hyperventilate only with cerebral herniation syndrome  Monitor ventilation with capnography  Fluid administration titrated to systolic BP –Preschool child: 80 mmHg; older child: 90 mmHg  Be prepared to prevent aspiration

25 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Life-Threatening Injuries Chest injury –Respiratory distress common –Pneumothorax or tension pneumothorax  Difficult to assess  Needle thoracostomy can be lifesaving –Pulmonary contusion –Rare injuries  Rib fractures, flail chest, aortic rupture, pericardial tamponade

26 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Life-Threatening Injuries Abdominal injury –Liver and/or spleen rupture  Second leading cause of traumatic death  Bleeding often contained within organ –Difficult to diagnose  Severe injury with minimal signs  Suspect with any abnormal abdominal assessment –Be prepared to prevent aspiration

27 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Life-Threatening Injuries Spinal injury –Uncommon before adolescence  <9 years usually upper cervical-spine injuries  >9 years usually lower cervical-spine injuries –SMR  Pad under torso for neutral position  May have to secure without cervical collar  Do not restrict chest movement

28 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Child Restraint Seats Child in car seat –Serious injury  Remove from car seat  Apply SMR –No apparent injury  Secure and transport in car seat Courtesy of Louis B. Mallory, MBA, REMT-P

29 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Child Neglect and Abuse A leading cause of death in U.S. –Be alert to signs –Transport if suspected –Know local laws © Pearson

30 International Trauma Life Support for Emergency Care Providers, Seventh Edition John Campbell Alabama College of Emergency Physicians Summary Good trauma care for children –Proper equipment –Interact with frightened parents –Know normal vital signs for various ages  Reference chart –Be familiar with common injuries in children –Be active in prevention programs


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