trauma in children 17- 1

Chapter
XVII
TRAUMA IN
CHILDREN
trauma in children 17- 2
Overview
Communications with
children and parents
Equipment for managing
pediatric patients
Assessment and management
Injury prevention
trauma in children 17- 3
Approach to the
Pediatric Patient
Be positive and choose words
carefully.
Explain what you are doing and why
you are doing it.
Particularly patient packaging
Use equipment appropriate for the
pediatric patient.
Always do what is best for the patient.
Always be an advocate for the child.
trauma in children 17- 4
Parents

Communicate with parents & child.
Be confident and professional.
Both in manner and dress
Try to involve parents in care of the
child.
Try not to separate family members.
Always do what is best for the patient.
Consider parents when treating
the child.
trauma in children 17- 5
Equipment
Obtain appropriate equipment to
treat pediatric patients.
Create a Pediatric Trauma Kit.
Use Broselow tape to organize the
equipment.
Sort equipment by size and age.
Place copy of normal vital signs for age in
the top of the kit.

trauma in children 17- 6
Length-Based
Resusication Tapes
trauma in children 17- 7
Scene Size-up
Falls most common mechanism.
Think head injury.
Motor vehicle collisions frequently
cause internal injuries.
Suspect abuse if:
History does not match the injury.
Delay in seeking help.
Story keeps changing.
Know your states EMS requirements
about reporting suspected abuse.
trauma in children 17- 8
Assessment
Same as for other trauma patients
Scene Size-up
BTLS Primary Survey
Initial Exam
Rapid Trauma Survey vs. Focused
Exam
Transport decision and Critical
interventions
Ongoing Exam
Detailed Exam

trauma in children 17- 9
Normal Values:
Respiration
Newborn 30-50
Infant 30-40
Older child 20-30
Respiration >40/min suggests
respiratory distress (except in
newborns).
trauma in children 17- 10
Normal Values:
Heart Rate
Newborn 120-160
6 mo-1 yr 120-140
2-4 yrs 100-110
5-8 yrs 90-100
>8 yrs 80-100
Weak, rapid pulse with rate >130
suggests shock in all except
newborns.
trauma in children 17- 11
Normal Values: Systolic
Blood Pressure
Newborn >60
6 mo-1 yr 70-80
2-4 years 80-90
5-8 years 90-100
8-12 years 100-110
>12 years 100-120
trauma in children 17- 12
Estimating Normal
Systolic BP
80 + (age in years x 2)

Systolic BP <80 in children and
<70 in infants suggests shock.
trauma in children 17- 13
Airway Control
Neutral positionpad under shoulders
Jaw thrust
Oral airway
Nasopharyngeal airway too small for children
Bulb suction
Neonates obligatory nose breathers
Pediatric BVM
Without pop-off valve
Appropriate size face mask
trauma in children 17- 14
Airway Control
Use orotracheal intubation.
Endotracheal tube size:
About size of patients little finger
About size of external nares
No cuffed tubes until at least 6mm size
Size of tube = 4 + 1/4 age in years
Use length-based tape for correct size
tube.
trauma in children 17- 15
Circulatory Assessment
Level of consciousness
Heart rate
>130 suggests shock in all except
newborns
Blood pressure
<80 suggests shock in all except infants
Skin color and condition
trauma in children 17- 16
Advanced Procedures
Intubation and IVs are often
very difficult in the field.
If possible, delay advanced
procedures until you reach the
emergency department.
trauma in children 17- 17
Shock Management
Rapid Assessment.
Airway with cervical spine control.
High-flow oxygen.
Control bleeding.
Possible IV/IO access.
20cc/Kg bolus NS
Rapid transport.
trauma in children 17- 18
Head Injuries
Rapid Assessment.
Airway with cervical spine control.
High-flow oxygen.
Maintain blood pressure.
Prevent aspiration.
Record GCS.
Consider intubation for 8 or less.
Most common cause of traumatic death
in children
trauma in children 17- 19
Chest Injuries
Rapid Assessment.
Rib fractures and flail chest rare.
Pneumothorax and pulmonary
contusion are common.
Signs of respiratory distress:
Tachypnea (rate >40)
Grunting
Nasal flaring
Retractions
trauma in children 17- 20
Abdominal Injuries
Blunt abdominal injury
Second leading cause of traumatic
death in children.
Rapid Assessment.
Be prepared to treat for shock.
Shock shows up late in children.
Continual reassessment.
trauma in children 17- 21
Spinal Injuries
Rare before adolescence but disastrous when
they occur.
Same indications for packaging as for
adults.
Use a pad under the shoulder to keep the
neck neutral.
Restrict movement of the head and neck
with cervical collar or other appropriate
device.
Cervical collar not necessary if head is
properly motion-restricted.

trauma in children 17- 22
Child Restraint Seats
The child with no
apparent injury may be
packaged and
transported in the seat.
The child with injuries
should be removed and
packaged on a
backboard.
trauma in children 17- 23
Prevention
Educate parents and children:
Use of car seats
Airbags
Use of seat belts
Water safety
Fire drills
Helmet use
ATVs
Airbags
trauma in children 17- 24
Summary
Anticipate problems unique to
children.
Try not to separate children from
parents.
Know (or have available) normal
values for children.
Have correct equipment.
Notify Medical Direction early.
Always be an advocate for the child.
trauma in children 17- 25

Questions?