Committee on Trauma Presents ©ACS Pediatric Trauma.

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Presentation transcript:

Committee on Trauma Presents ©ACS Pediatric Trauma

Objectives  Identify unique characteristics of the pediatric trauma patient  Identify injury patterns in children  Discuss application of ATLS management principles to the injured child ©ACS

Key Questions  What type of injuries do children sustain?  What aspects of childhood anatomy do I need to consider?  What physiologic differences will impact on my management?  How do I apply the ATLS principles to the child?  How do I recognize abuse injuries? ©ACS

Type of injuries sustained?  Age-related mechanism of injury  Injury mortality surpasses all other diseases  Mechanisms and patterns of injury ©ACS

Anatomic considerations? ©ACS Airway, Head, and Neck Open fontanelles Narrow, short airway Pad under torso Neutral position

Anatomic Considerations? ©ACS Chest  Pliable, soft wall  Chest injuries poorly tolerated

Anatomic Considerations? ©ACS Abdomen  Softer, thinner wall  Lower-riding liver, spleen

Anatomic Considerations? ©ACS Spine   Flexibility  SCIWORA

Anatomic considerations? ©ACS Thermoregulation  High ratio of BSA to body mass  Thin skin  Lack of subcutaneous tissue Prevent hypothermia

Impact of physiologic issues?  Vital signs  Increased cardiovascular reserve  Cerebral blood flow ©ACS

Management Issues: Vital Signs ©ACS Sign 0-3 years3–5 years 6–12 years HR < < 140< BP > > 75> RR< < 35< 30

Management Issues: Output ©ACS Years 2 mL / kg Years 1 mL / kg Years mL / kg

A B C D Priorities are the same! Management Issues: ABCDEs ©ACS E

Management Issues: ABCDEs ©ACS Size of uncuffed ET tube Compliant ribs, chest tube size Fluid challenge, use of blood E A B C D GCS Score, pediatric verbal score Prevent heat loss

FAST Management: Adjuncts ©ACS DPL T U B E S CT

Recognize abuse injuries? History  Multicolored bruises  Retinal hemorrhages  Bilateral subdurals  Femur fracture(s)  Unusual scald / contact burns ©ACS  Discrepancies  Delay in care  Repetitive injuries  Inappropriate responses  Medical neglect Physical

©ACS

Summary  Management principles are the same.  Unique anatomic and physiologic differences modify the application of ATLS principles  High index of suspicion for child abuse  Involve the surgeon early! ©ACS