1. Pediatric Trauma for the E.M.S. Current Concepts on Evaluation and Treatment Dr. Donald W. Kucharzyk Pediatric Orthopaedic Surgeon The Orthopaedic, Pediatric & Spine Institute

2. Pediatric Trauma for the E.M.S. zApproach to the Polytrauma Patient zIdentify the Most Common Pediatric Orthopaedic Fractures zAssess and Institute appropriate Initial Treatment Plans zIdentify Potential Complications and Appropriate Treatment Initiatives

3. Pediatric Trauma for the E.M.S. POLYTRAUMA zPrimary Cause of Serious Injuries in Childhood z45% caused by automobiles (15% passenger and 30% pedestrian) z40% caused by falls z100,000 children are crippled z15,000 children die (accounts for one half the deaths in those under 15 years)

4. Pediatric Trauma for the E.M.S. z50% have associated head injury z30-50% have an extremity injury z42% have an injury to the spine z25% have an injury to the chest z15% have abdominal injury zWADDELL’S TRIAD: fracture of the femur, injury to the thorax on the same side, and contralateral head injury

5. Pediatric Trauma for the E.M.S. INITIAL EVALUATION zEvaluate the Status of the Airway zIdentify for the Presence of Hemorrhage and Shock zDetermine the State of Consciousness zEvaluate for Internal Injuries zEvaluate the Spine zEvaluate the Extremities

6. Pediatric Trauma for the E.M.S. zMaintenance of Airway may require intubation zEstablish IV access zMaintain Arterial Blood Pressure zInsert Nasogastric Tube zCardiac Monitoring zSpinal Immobilization

7. Pediatric Trauma for the E.M.S. zEstablish Appropriate Vascular Status of the Extremities zAssess Extremities for Fractures and Dislocations zSplint Extremity Injuries zTransport to Emergency Medical Facility

8. Pediatric Trauma for the E.M.S. SPINAL IMMOBILIZATION Spinal Injuries z24% incidence of multi-level injuries zChildren under 6 years: immobilize with the split mattress technique to elevate the thorax and lower the occiput zRoutine immobilization of Children older than 6 years

9. Pediatric Trauma for the E.M.S. zReason for difference in immobilization: children have larger heads and increased incidence of kyphosis and anterior translation of upper cervical segments zStabilize the remaining Spinal Injuries via routine Back Board Immobilization

10. Pediatric Trauma for the E.M.S. EXTREMITY EVALUATION zAssess Circulatory Status via evaluation of presence of pulse, color, and capillary filling zAssess for Deformity, Angulation, Excessive Motion, and Crepitance zNeurologic Assessment if possible (may be difficult in pediatric patient, attempt to see response to stimulation)

11. Pediatric Trauma for the E.M.S. zSplint Extremity in Position of Comfort zUpper Extremity: Long Arm Splint zShoulder: Sling and Swathe zFemur: Hare Traction Splint zLower Extremity: Long Leg Splint zAlways re-assess the status of the circulation and neurologic of the extremity

12. Pediatric Trauma for the E.M.S. ASSOCIATED INJURIES zHead Injuries: 90% with heqd injuries recover from a coma in 48 hours. zGlasgow Coma Scale important; scores of over 5 tend to recover fully. zChest Injuries: 97% caused by blunt trauma with 68% having associated orthopaedic injuries; 50% have pulmonary contusions; 37% incidence pneumothorax

13. Pediatric Trauma for the E.M.S. PEDIATRIC ORTHOPEADIC FRACTURE PATTERNS

14. Pediatric Trauma for the E.M.S. Pediatric Upper Extremity zHumeral Fractures usually Growth Plate Injuries zElbow Dislocations rare under 4 years old; Think Transepiphyseal Fracture; Dislocations go Lateral, Fractures go Medial zElbow Fractures: Think Supracondylar

15. Pediatric Trauma for the E.M.S. Pediatric Upper Extremity zSupracondylar Fracture: Evaluate for Compartment Syndrome if Severe Pain zForearm Fractures: Watch for Swelling zWrist Fractures: Watch for Neurologic and Compartment Syndrome

16. Pediatric Trauma for the E.M.S. Pediatric Lower Extremity zHip Fractures: Severe Injury End Result Poor; Externally Rotated as Adult; Internally Rotated Dislocated zFemur Fractures: High Blood Loss Potential and also Vascular/Neurologic injuries zKnee Injuries: Think Distal Femur Fracture (Growth Plate)

17. Pediatric Trauma for the E.M.S. Pediatric Lower Extremity zKnee Ligamentous Injury Rare zKnee Dislocation Rare zTibial Fractures: Think Potential Compartment Syndrome zAnkle Fractures: Usually Growth Plate Injuries zAnkle Dislocations Rare

18. Pediatric Trauma for the E.M.S. Pediatric Lower Extremity zAnkle Fractures: Complex and MultiPlanar Growth Plate Injuries zFoot Injuries: May be Crush Injury and Think Compartment Syndrome zLower Extremity Injuries can be associated with Soft Tissue Involvement and Associated with Compartment Syndrome

19. Pediatric Trauma for the E.M.S. PEDIATRIC ORTHOPEADIC COMPLICATIONS

20. Pediatric Trauma for the E.M.S. PEDIATRIC ORTHOPAEDIC FRACTURE PEARLS AND WISDOM

21. Pediatric Trauma for the E.M.S. zPediatric Patients are NOT LITTLE Adults and can’t be treated as such zMultitude of Growth Plates make even simple injuries sometimes severe long term problems zAlways Splint the Fracture Above and Below the affected area and constantly assess vascular and neurologic zWatch Out for Compartment Syndrome

22. Pediatric Trauma for the E.M.S. zPediatric Injuries can Affect Multiple Area’s and can have Multiple Organ System involvement and Injuries zSpinal Immobilization Different than Adult or Older Child; Watch Age for Type of Immobilization zWith Spinal Injuries: When in Doubt Immobilize and Protect Against Injury

23. Pediatric Trauma for the E.M.S. THANK YOU Dr. Donald W. Kucharzyk