No Slide Title

Pediatric TraumaPediatric Trauma

Temple CollegeTemple College

EMS ProfessionsEMS Professions

Pediatric TraumaPediatric Trauma

n#1 killer after neonatal periodn#1 killer after neonatal period

nPriorities same as in adultsnPriorities same as in adults

nABC’snABC’s

Children are not just little adults!

AirwayAirway

nAnatomy increases upper airwayobstruction risknAnatomy increases upper airwayobstruction risk

–Large head–Large head

–Short neck–Short neck

–Small mandible–Small mandible

–Large, posteriorly placed tongue–Large, posteriorly placed tongue

nChildren do NOT mouth breathe wellnChildren do NOT mouth breathe well

AirwayAirway

nNeck over-extension may obstructairway due to high glottisnNeck over-extension may obstructairway due to high glottis

nUse sniffing position if neck injurynot suspectednUse sniffing position if neck injurynot suspected

nChin lift important to get tongue outof airwaynChin lift important to get tongue outof airway

BreathingBreathing

nSmall passages obstruct easilynSmall passages obstruct easily

nHorizontal ribs, weak accessorymuscles = Poor respiratory reservenHorizontal ribs, weak accessorymuscles = Poor respiratory reserve

nSwallowed air may limit ventilationsnSwallowed air may limit ventilations

nAnticipate need to assist ventilationnAnticipate need to assist ventilation

BreathingBreathing

nFast breathing may be normalnFast breathing may be normal

nBreathing at normal adult rates (10-20/min)may indicate respiratory failurenBreathing at normal adult rates (10-20/min)may indicate respiratory failure

nAuscultation of chest may be misleading(transmitted breath sounds)nAuscultation of chest may be misleading(transmitted breath sounds)

BreathingBreathing

nHigh metabolic rates + Low reservecapacity = High sensitivity to airway,breathing problemsnHigh metabolic rates + Low reservecapacity = High sensitivity to airway,breathing problems

nOxygenate, ventilate aggressivelynOxygenate, ventilate aggressively

CirculationCirculation

nRapid control of external bleedingessential due to small blood volumenRapid control of external bleedingessential due to small blood volume

nEfficient compensation makesrecognition of shock difficultnEfficient compensation makesrecognition of shock difficult

nSudden decompensation, onset ofirreversible shock may occurnSudden decompensation, onset ofirreversible shock may occur

CirculationCirculation

nBP monitoring = Poor shock indicatornBP monitoring = Poor shock indicator

nAssess perfusion using:nAssess perfusion using:

–Peripheral pulse rate, quality–Peripheral pulse rate, quality

–Skin color, temperature–Skin color, temperature

–LOC (Silence is not Golden)–LOC (Silence is not Golden)

–Capillary refill–Capillary refill

ManagementManagement

nAirwaynAirway

n100 % O2n100 % O2

nConsider early ventilationnConsider early ventilation

nPrevent hypothermianPrevent hypothermia

–Large surface/volume ratio =increased heat loss–Large surface/volume ratio =increased heat loss

–Cover with blanket–Cover with blanket

Head TraumaHead Trauma

nMajor cause of deathnMajor cause of death

–Large heads–Large heads

–Thin skulls–Thin skulls

–Poor muscle control–Poor muscle control

nDiffuse edema more common thanintracranial hematomasnDiffuse edema more common thanintracranial hematomas

Head TraumaHead Trauma

nMonitor for signs of increased ICPnMonitor for signs of increased ICP

–AVPU–AVPU

–Pupils–Pupils

–Vomiting–Vomiting

–Cushing’s triad–Cushing’s triad

nHyperventilatenHyperventilate

nResuscitate hypovolemic shock aggressivelynResuscitate hypovolemic shock aggressively

Spinal TraumaSpinal Trauma

nUncommonnUncommon

–Usually occur at C1, C2, C3 (high C-spine)–Usually occur at C1, C2, C3 (high C-spine)

–Dislocations more common than fractures–Dislocations more common than fractures

nSuspect if trauma involves:nSuspect if trauma involves:

–Sudden deceleration–Sudden deceleration

–Head injuries–Head injuries

–Decreased LOC–Decreased LOC

nResist temptation to pick child up and run!nResist temptation to pick child up and run!

Chest TraumaChest Trauma

nSecond only to head trauma as causeof trauma deathsnSecond only to head trauma as causeof trauma deaths

n90% bluntn90% blunt

nChest wall flexible:nChest wall flexible:

–Rib fracture uncommon–Rib fracture uncommon

–Extensive intrathoracic injury canoccur without rib fracture–Extensive intrathoracic injury canoccur without rib fracture

Chest TraumaChest Trauma

nMobile mediastinumnMobile mediastinum

–Poor tension pneumothorax tolerance–Poor tension pneumothorax tolerance

nLimited respiratory reservenLimited respiratory reserve

–Poor chest injury tolerance–Poor chest injury tolerance

Abdominal TraumaAbdominal Trauma

nMost common pediatric trauma formnMost common pediatric trauma form

nUsually bluntnUsually blunt

nLiver, spleen injury more commonthan in adultsnLiver, spleen injury more commonthan in adults

–High, broad costal arch–High, broad costal arch

–Relatively larger organs–Relatively larger organs

–Weak abdominal wall–Weak abdominal wall

Abdominal TraumaAbdominal Trauma

nTenderness = Significant traumauntil proven otherwisenTenderness = Significant traumauntil proven otherwise

nDistension = Significant trauma untilproven otherwisenDistension = Significant trauma untilproven otherwise

Extremity TraumaExtremity Trauma

nNever severe enough to warrant attentionbefore head, chest, abdominal injurynNever severe enough to warrant attentionbefore head, chest, abdominal injury

nPriorities remain with ABC’snPriorities remain with ABC’s

nPliant bones absorb/ dissipate significant forcenPliant bones absorb/ dissipate significant force

–Greenstick fractures common–Greenstick fractures common

–Treat painful, tender, guarded extremities asfractures–Treat painful, tender, guarded extremities asfractures

BurnsBurns

nChildren account for:nChildren account for:

–50% of burn admissions–50% of burn admissions

–33% burn deaths–33% burn deaths

nLarge body surface area increases:nLarge body surface area increases:

–Fluid loss–Fluid loss

–Heat loss (hypothermia risk)–Heat loss (hypothermia risk)

nSmaller airwaynSmaller airway

–Increased obstruction risk–Increased obstruction risk

BurnsBurns

nConsider possibility of child abuse:nConsider possibility of child abuse:

–Story does not match pattern of burn–Story does not match pattern of burn

–“Stocking” or “glove” injury–“Stocking” or “glove” injury

–Unusually deep burns–Unusually deep burns