Anda di halaman 1dari 22

1

ACS

Pediatric Trauma
2
ACS

Objectives

Identify unique characteristics of


children.
Discuss and demonstrate primary
management of pediatric trauma.
Identify injury patterns of child abuse.
3
ACS

Special Considerations
Size and shape
Skeleton
Surface area
Psychologic status
Long-term effects
Equipment
4
ACS

Airway

Anatomy
Craniofacial disproportion
Large occiput cervical flexion
Infants : Obligate nasal breathers
Larynx : Anterior caudad angle
Trachea : Short
5
ACS

Airway
Management
Head : Sniffing position
Suction, oxygenate, ventilate
Endotracheal intubation
Needle cricothyroidotomy
6
ACS

Rapid Sequence Intubation


Preoxygenate

Sedation / Atropine

Hypovolemic Normovolemic
(Midazolam*) (Thiopental*)

Cricoid Pressure

Paralysis*
(Succinylcholine)

*Caution Intubate, Check Tube Position


7
ACS

Breathing / Ventilation
Assessment and Management
Rate
Tidal volume
Pressure
Caution : Hypoventilation
Tube thoracostomy
8
ACS

Hemodynamic Changes
9
ACS

Shock Management
Fluid Resucitation
Blood volume = 80 mL/kg
Bolus : 20 mL/kg warmed Ringers lactate
solution (may repeat x 2)
Consider PRBCs with 3rd fluid bolus
Temperature regulation
10
ACS

Shock Management
Responses to Treatment
Usual Common Rare

Crystalloid Crystalloids Crystalloids


bolus + PRBCs + PRBCs,
If no
Normal Normal
Operation
No operation No operation
11
ACS

Shock Management

Blood Replacement
10 ml/kg PRBCs
Type specific or O-negative
Warmed
Immediate surgical consult!
12
ACS

Shock Management
Venous Access
Percutaneous peripheral
Intraosseous : 6 years
Cutdown : Saphenous at ankle / groin
Special lines
13
ACS

Chest Trauma
Rib fracture : Severe injuring force
Compilant chest wall : Lung contusion
Mediastinal mobility :sensitivity to
pulmonary injury
Thoracotomy : Usually not needed
Other organ system injuries
14
ACS

Abdominal Trauma
Method of assessment
Gastric distention
Urinary catheter
Diagnostic adjuncts
CT with contrast

DPL / Ultrasonography
15
ACS

Abdominal Trauma

Management

Nonoperative Operation

Decision by Surgeon
16
ACS

Head Trauma
Differences
Anatomic : fontanelles, suture lines
Outcome
Extracranial injuries
Hypotension Management
Secondary brain injury same as adult
17
ACS

Head Trauma
Pediatric Verbal Response Score
Appropriate words, response 5
Cries but consolable 4
Persistently irritable 3
Restless, agitated 2
None 1

(Pediatric Modification of GCS for verbal)


18
ACS

Spinal Cord Injury


Differences
Interspinous ligaments, joint capsules

Vertebrae, wedged anteriorly

Flat facets

Larger head

X-ray considerations
Treatment
19
ACS

Musculoskeletal Trauma

Management principles same


History important
Growth plate frequently involved
Blood loss proportionately greater
Unique fractures
20
ACS

Child Abuse
History
Injury patterns
21
ACS

Questions
22
ACS

Summary

Same management principles as for adults


Unique anatomic and physiologic
differences
Involve surgeon early !