Chapter 10 and 11

 Identify unique characteristics of the pediatric, elderly and female patient  Identify unique injury patterns  Discuss applications of ATLS management principles to the unique population

 Anatomic considerations ◦ Narrow upper airway ◦ Anterior, funnel-shaped larynx ◦ Short trachea ◦ Pliable soft chest wall ◦ Softer thinner-walled abdomen ◦ Lower-riding liver ◦ Flexible spine ◦ Thin skin and high ratio BSA:body mass

Sign0 to 3 years3 to 5 years6 to 12 years HR<150 – 160<140<100 – 120 BP>60 – 70>75>80 – 90 RR<40 – 60<35<30 Urinary output2 mL/kg1 mL/kg0.5 mL/kg  Management priorities are still the same!  A - Size of uncuffed ET tube  B - Compliant ribs, chest tube size  C - Fluid challenge, use of blood  D - GCS score, pediatric verbal score  E - Prevent heat loss

 Physiologic changes  Pre-existing diseases  Medications  Increasing age and decreasing organ function

 Difficult intubation: cervical arthritis, mucosal fragility  Unique breathing problems: diminished reserve, COPD, chest injuries poorly tolerated  Unique circulatory problems: fixed HR, hypertension, limited reserve, renal function, medications  Unique neuro problems: subdural hematomas, altered sensorium, spinal osteoarthritis

 Exposure: increased sensitivity to hypothermia  MSK: most frequent cause of morbidity, osteoporosis, fractures, preexisting deformities, immobility may lead to complications

 Is she pregnant? ◦ Ask, uterine enlargement, pregnancy test  Pregnancy changes: ◦ Uterus intrapelvic and thick-walled in 1 st trimester ◦ Uterus extrapelvic and large volume fluid in 2 nd ◦ Uterus thin-walled and displaced organs in 3 rd  Pregnancy risks: ◦ Pelvic fractures ◦ Abruptio placenta ◦ Amniotic fluid embolism

 A – Aspiration risk  B – Hyperventilation  C – Hypervolemia with anemia  D - Eclampsia

 A – same as non-pregnant  B – Same as non-pregnant  C – displace uterus/volume infusion  D – Eclampsia vs brain injury  E – same as non-pregnant

 Resuscitate the mother  Monitor fetal heart tones  Consider fetal injury with ◦ Vaginal bleeding ◦ Abruptio placenta ◦ Uterine tenderness ◦ Uterine rupture ◦ labor

 Is she pregnant?  What are the changes?  How do these changes affect injury patterns?  How do you manage both patients?