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Pediatric Trauma
Temple College
EMS Professions
Pediatric Trauma
#1 killer after neonatal period
Priorities same as in adults
ABC’s
Children are not just little adults!
Airway
Anatomy increases upper airway
obstruction risk
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Large head
Short neck
Small mandible
Large, posteriorly placed tongue
Children do NOT mouth breathe well
Airway
Neck over-extension may obstruct
airway due to high glottis
Use sniffing position if neck injury
not suspected
Chin lift important to get tongue out
of airway
Breathing
Small passages obstruct easily
Horizontal ribs, weak accessory
muscles = Poor respiratory reserve
Swallowed air may limit ventilations
Anticipate need to assist ventilation
Breathing
Fast breathing may be normal
Breathing at normal adult rates (10-20/min)
may indicate respiratory failure
Auscultation of chest may be misleading
(transmitted breath sounds)
Breathing
High metabolic rates + Low reserve
capacity = High sensitivity to airway,
breathing problems
Oxygenate, ventilate aggressively
Circulation
Rapid control of external bleeding
essential due to small blood volume
Efficient compensation makes
recognition of shock difficult
Sudden decompensation, onset of
irreversible shock may occur
Circulation
BP monitoring = Poor shock indicator
Assess perfusion using:
– Peripheral pulse rate, quality
– Skin color, temperature
– LOC (Silence is not Golden)
– Capillary refill
Management
Airway
100 % O2
Consider early ventilation
Prevent hypothermia
– Large surface/volume ratio =
increased heat loss
– Cover with blanket
Head Trauma
Major cause of death
– Large heads
– Thin skulls
– Poor muscle control
Diffuse edema more common than
intracranial hematomas
Head Trauma
Monitor for signs of increased ICP
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AVPU
Pupils
Vomiting
Cushing’s triad
Hyperventilate
Resuscitate hypovolemic shock aggressively
Spinal Trauma
Uncommon
– Usually occur at C1, C2, C3 (high C-spine)
– Dislocations more common than fractures
Suspect if trauma involves:
– Sudden deceleration
– Head injuries
– Decreased LOC
Resist temptation to pick child up and run!
Chest Trauma
Second only to head trauma as cause
of trauma deaths
90% blunt
Chest wall flexible:
– Rib fracture uncommon
– Extensive intrathoracic injury can
occur without rib fracture
Chest Trauma
Mobile mediastinum
– Poor tension pneumothorax tolerance
Limited respiratory reserve
– Poor chest injury tolerance
Abdominal Trauma
Most common pediatric trauma form
Usually blunt
Liver, spleen injury more common
than in adults
– High, broad costal arch
– Relatively larger organs
– Weak abdominal wall
Abdominal Trauma
Tenderness = Significant trauma
until proven otherwise
Distension = Significant trauma until
proven otherwise
Extremity Trauma
Never severe enough to warrant attention
before head, chest, abdominal injury
Priorities remain with ABC’s
Pliant bones absorb/ dissipate significant force
– Greenstick fractures common
– Treat painful, tender, guarded extremities as
fractures
Burns
Children account for:
– 50% of burn admissions
– 33% burn deaths
Large body surface area increases:
– Fluid loss
– Heat loss (hypothermia risk)
Smaller airway
– Increased obstruction risk
Burns
Consider possibility of child abuse:
– Story does not match pattern of burn
– “Stocking” or “glove” injury
– Unusually deep burns