1. TRANSITION SERIES Topics for the Advanced EMT CHAPTER Trauma in Special Populations: Pediatrics 41

2. Objectives Discuss the incidence of pediatric trauma and death. Identify disease patterns and assessment findings common to pediatric trauma. Review “organ-specific care” that is integral to pediatric trauma management.

3. Introduction Children have unique anatomic and physiologic characteristics. They are more likely to suffer multi- organ system involvement. Unrecognized trauma leads to higher morbidity and mortality than in adults. Advanced EMTs must appropriately recognize and adequately treat pediatric trauma patients.

4. Epidemiology Over 300,000 pediatric hospitalizations a year are due to trauma. 40% of injuries are sustained from motor vehicle trauma. Pediatric trauma patients continue to have the worst outcomes during resuscitation.

5. Trauma Scoring Systems Functions of Systems –Tool for triage and treatment decisions –Tool for predicting the severity of the illness or mortality –Most widely used is Glasgow Coma Scale

6. Pediatric Glasgow Coma Scale

9. Assessment and Care Anatomical and Physiologic Differences –Airway, oxygenation, and ventilation  Smaller midface  Larger tongue  Narrow nares and lower airways  Glottic opening higher and anterior  Short neck

10. Assessment and Care (cont’d) Anatomical and Physiologic Differences (continued) –Breathing  If GCS is less than 12, the patient may need assistance.  Hyper- and hypoventilation have been implicated in poorer outcomes upon arrival at ED.  Use age-appropriate rate for ventilation.  Inflate just enough to see the chest rise.

11. Assessment and Care (cont’d) Anatomical and Physiologic Differences (continued) –Circulation  Blood volume varies by age.  Infants have 100 mL/kg, adults have 50 mL/kg.  Minimal blood loss can precipitate hypoperfusion syndrome.

12. Assessment and Care (cont’d) Anatomical and Physiologic Differences (continued) –Circulation  Indications of hypoperfusion include tachycardia, poor peripheral perfusion, altered mental status, poor muscle tone.  Obtain IV access and administer up to three 20 mL/kg boluses based on patient presentation.

13. Assessment and Care (cont’d) Organ-Specific Care –Cerebral blood flow  An acutely injured brain is susceptible to any other blood disturbance  Delivery of oxygen and removal of waste must be ongoing.  The need for maintaining normoxia and normocarbia is imperative

14. Assessment and Care (cont’d) Organ-Specific Care (continued) –Head, neck, spine  Waddell triad  Head injuries and brain injuries are implicated in 80% of pediatric trauma deaths.  Remain acutely aware of mental status.  Maintain normothermia.  Immobilization may need to be modified.

15. Assessment and Care (cont’d) Organ-Specific Care (continued) –Chest  Delayed ossification of ribs.  Energy is transmitted to organs.  Twice as likely to sustain thoracic or abdominal organ trauma.

16. Assessment and Care (cont’d) Organ-Specific Care (continued) –Multi-organ system trauma  Injuries most highly associated with death are cardiac tamponade (70%), hemothorax (50%), cardiac injury (48%), injury to aorta (42%), flail chest (40%), and tension pneumothorax (39%).

17. Assessment and Care (cont’d) Organ-Specific Care (continued) –Abdomen and pelvis  Internal hemorrhage from the liver or spleen can kill the child quickly.  Abdominal distention inhibits diaphragm motion.  Bleeding may also occur, like adults, from pelvic trauma.

18. Assessment and Care (cont’d) Organ Specific Care (continued) –Skeletal injuries  The younger the patient, the more flexible the bone and the harder it is to break it.  Toddlers are the youngest patients in whom accidental fractures are seen.  Trauma in infants is often inflicted by others.

19. Summary Pediatric patients are often problematic for care providers due to anatomical differences, equipment need differences, and lack of exposure.

20. Summary (cont’d) Apprehension that comes from dealing with pediatrics needs to be eliminated. Uncertainty, poor skill, or inadequate judgment on the Advanced EMT's part can be fatal to the pediatric patient.