1. Trauma Roger M. Barkin, MD, MPH, FAAP, FACEP

2. Epidemiology of Trauma l Age Leading cause of death in children > 8 mos in US >28% of trauma victims <3 mos due to neglect/ abuse l Numbers per year in US Deaths 22,000 Hospitalizations 600,000 ED visits16 million

3. Causes of Death due to Trauma Housefires34% Firearms19% Drowning11% MVA 7% ( MVA is leading cause of death in children up to 19 years of age)

4. Risk Factors l 28% of trauma in children <3 mos. related to abuse/neglect l Inadequate supervision l Developmental inadequacy of child to perform task l Inadequate attention to task l Showing off l Risk taking l Drugs /alcohol

5. Approaches l Aggressive Management Treatment based on clinical findings Assume the most serious diagnosis Consider the nature of the accident- mechanism Thorough examination Frequent reassessment

6. Approaches l Technical Steps IV tubes NG tubes Urinary catheter Cardiac monitor Labs and x-rays

7. Unique Aspects of Pediatric Trauma l 80% is blunt trauma l 80% of multiple trauma involve head l Temperature regulation l Body surface area and fluid loss

8. Unique Anatomic Aspects Cervical spine has high risk potential because of relatively large head <8 yearusually occiput, C1 or C2 >8 yearusually lower C spine

9. Unique Anatomic Aspects l Abdominal contents pelvic versus abdominal liver and spleen relatively large abdominal distention

10. Unique Anatomic Aspects l Chest Wall flexibility diaphragmatic breather

11. Unique Anatomic Aspects l Musculoskeletal Injury Salter-Harris classification Unique injuries greenstick buckle

12. Disposition l Initial acute management l Rehabilitation