Chapter 40 Pediatric Trauma Emergencies

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 2 Overview  Pediatric Trauma Assessments  Blunt Trauma  Burns  Child Abuse  Children with Special Needs

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 3  Anatomic differences –Related to physical development –Head is larger in proportion to body, making children top heavy –Higher ratio of body surface area to mass makes children prone to hypothermia Pediatric Trauma Assessment

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 4 Pediatric Trauma Assessment  Mechanism of injury –Death from trauma is more frequent in children –Small children lack the understanding that injury can occur –Adolescents knowingly participate in risky behavior

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6  Initial assessment –Compare the actions of a sick child to those of a normal child –A child’s smaller airway is more prone to obstruction –Underdeveloped musculature in the chest may increase breathing difficulty –Smaller blood volume than an adult can lead to life threatening conditions Pediatric Trauma Assessment

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 7 Stop and Review  What are the typical causes of pediatric trauma?  What are the anatomic differences between a child and an adult?  What are the indications for transporting a child to a trauma center?

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 8 Blunt Trauma  Need to compare size of child to MOI  Can cause internal bleeding, hypoperfusion, shock  Signs of blunt trauma in children may be subtle

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 9 Blunt Trauma  Hypoperfusion –Compensate for blood loss well; however, decompensation occurs quickly –Pale, diaphoretic, increased capillary refill, nausea –Compare radial and carotid pulses to determine if shunting is occurring –Loss of consciousness and bradycardia are signs of imminent cardiac arrest

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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 11 Blunt Trauma  Chest injury –A child’s ribs consist mainly of cartilage and are very flexible –Ribs can bend inward and create underlying injury –Oxygenate, ventilate, and stabilize as necessary

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 12 Blunt Trauma  Spinal injury –In deceleration injuries, the child is more prone to spinal trauma because of the heaviness of his head –Manual stabilization and oxygen administration are key to managing the child with spinal injury

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 13 Blunt Trauma  Abdominal injury –The liver and spleen are only partially protected by rib cage –These structures can be torn or ruptured during blunt trauma to the abdomen

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 14 Blunt Trauma  Head injury –Loss of consciousness, headache, blurred vision –Nausea and vomiting are more common in children –Post-traumatic seizures may also occur –Manage oxygenation, ventilation, and circulation

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 15 Blunt Trauma  Spinal immobilization –A car seat does not provide proper immobilization –Padding is necessary if the child is left in a car seat –If removed from the car seat, a cervical collar or padding may be used

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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 17 Blunt Trauma  Bony injury –Somewhat flexible, seldom break –There may be other injuries if a fracture is observed –Immobilization and evaluation by a physician is the proper course of treatment

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 18 Burns  Maintain an open airway  Estimate the percentage of body surface area burned

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 19 Child Abuse  Be alert to patterns of injury that do not match the MOI  Wounds in various stages of healing may indicate abuse  The child’s story and caregiver’s story don’t match  The caregiver takes the child to many different hospitals

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 20 Courtesy of Emergency Medical Services for Children, NERA, Torrance, CA

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 21 Stop and Review  How would an EMT manage the pediatric patient with a: –Chest injury –Abdominal injury –Spinal cord injury –Long bone fracture –Injuries from suspected child abuse

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 22 Children with Special Needs  Tracheostomies –A surgical opening in the front of the neck for placement of a tube used as an artificial airway –Secretions may cause obstruction or difficulty breathing –Oxygenation and ventilation should be provided through the tube

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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 24 Children with Special Needs  Mechanical ventilators –Machines to help with breathing –Do not attempt to manipulate the ventilator –Disconnect the ventilator and use a BVM for ventilations –Call for an ALS intercept –If the child needs to be transported for reasons not related to the ventilator, transport the ventilator with the child

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 25 Children with Special Needs  Central venous catheters –A tube placed within a large vein for repeated access to the vein –Keep the site clean –Clamp the tube if bleeding is occurring at the catheter site

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 26 Children with Special Needs  Feeding tubes –Soft, flexible tubes placed within the stomach through the nose or the abdominal wall –Used to provide liquid nutrition –Rarely result in emergencies related to the tube itself –Keep the tube clean and avoid pulling on it

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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 28 Children with Special Needs  Cerebrospinal fluid shunts –A catheter used to drain excess fluid from the brain and into the abdomen –Infection can cause problems with the shunt –Intracranial pressure may rise if the shunt is not working properly

© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 29 Stop and Review  How should the EMT respond to children with special needs?