1. Pediatric Trauma Temple College EMS Professions

2. Pediatric Trauma n #1 killer after neonatal period n Priorities same as in adults n ABC’s Children are not just little adults!

3. Airway n Anatomy increases upper airway obstruction risk –Large head –Short neck –Small mandible –Large, posteriorly placed tongue n Children do NOT mouth breathe well

4. Airway n Neck over-extension may obstruct airway due to high glottis n Use sniffing position if neck injury not suspected n Chin lift important to get tongue out of airway

5. Breathing n Small passages obstruct easily n Horizontal ribs, weak accessory muscles = Poor respiratory reserve n Swallowed air may limit ventilations n Anticipate need to assist ventilation

6. Breathing n Fast breathing may be normal n Breathing at normal adult rates (10-20/min) may indicate respiratory failure n Auscultation of chest may be misleading (transmitted breath sounds)

7. Breathing n High metabolic rates + Low reserve capacity = High sensitivity to airway, breathing problems n Oxygenate, ventilate aggressively

8. Circulation n Rapid control of external bleeding essential due to small blood volume n Efficient compensation makes recognition of shock difficult n Sudden decompensation, onset of irreversible shock may occur

9. Circulation n BP monitoring = Poor shock indicator n Assess perfusion using: –Peripheral pulse rate, quality –Skin color, temperature –LOC (Silence is not Golden) –Capillary refill

10. Management n Airway n 100 % O 2 n Consider early ventilation n Prevent hypothermia –Large surface/volume ratio = increased heat loss –Cover with blanket

11. Head Trauma n Major cause of death –Large heads –Thin skulls –Poor muscle control n Diffuse edema more common than intracranial hematomas

12. Head Trauma n Monitor for signs of increased ICP –AVPU –Pupils –Vomiting –Cushing’s triad n Hyperventilate n Resuscitate hypovolemic shock aggressively

13. Spinal Trauma n Uncommon –Usually occur at C 1, C 2, C 3 (high C-spine) –Dislocations more common than fractures n Suspect if trauma involves: –Sudden deceleration –Head injuries –Decreased LOC n Resist temptation to pick child up and run!

14. Chest Trauma n Second only to head trauma as cause of trauma deaths n 90% blunt n Chest wall flexible: –Rib fracture uncommon –Extensive intrathoracic injury can occur without rib fracture

15. Chest Trauma n Mobile mediastinum –Poor tension pneumothorax tolerance n Limited respiratory reserve –Poor chest injury tolerance

16. Abdominal Trauma n Most common pediatric trauma form n Usually blunt n Liver, spleen injury more common than in adults –High, broad costal arch –Relatively larger organs –Weak abdominal wall

17. Abdominal Trauma n Tenderness = Significant trauma until proven otherwise n Distension = Significant trauma until proven otherwise

18. Extremity Trauma n Never severe enough to warrant attention before head, chest, abdominal injury n Priorities remain with ABC’s n Pliant bones absorb/ dissipate significant force –Greenstick fractures common –Treat painful, tender, guarded extremities as fractures

19. Burns n Children account for: –50% of burn admissions –33% burn deaths n Large body surface area increases: –Fluid loss –Heat loss (hypothermia risk) n Smaller airway –Increased obstruction risk

20. Burns n Consider possibility of child abuse: –Story does not match pattern of burn –“Stocking” or “glove” injury –Unusually deep burns