PAEDIATRIC TRAUMAPAEDIATRIC TRAUMA

Learning outcomesLearning outcomes

Approach to patientApproach to patient Differences compared to adult traumaDifferences compared to adult trauma Specific injuriesSpecific injuries

Head injuriesHead injuries Spinal injuriesSpinal injuries Abdominal injuriesAbdominal injuries ExtremitiesExtremities BurnsBurns

Children are not just little

adults!

TraumaTrauma

No 1 killer of after neonatal period No 1 killer of after neonatal period

50% of childhood deaths50% of childhood deaths

Cause of traumaCause of trauma

0-1 yrs – falls, burns, drowning, 0-1 yrs – falls, burns, drowning, suffocationsuffocation

1- 4yrs – RTC (occupant), burns, 1- 4yrs – RTC (occupant), burns, falls, drowningfalls, drowning

4-15yrs – RTC (occupant, pedestrian), 4-15yrs – RTC (occupant, pedestrian), bicycle injuries, burns, bicycle injuries, burns, drowningdrowning

Pediatric TraumaPediatric Trauma

Same PRIORITIES as adultsSame PRIORITIES as adults ABCABC’’s firsts first

Parents may want to be presentParents may want to be present

Remember analgesiaRemember analgesia

Airway - problemsAirway - problems

At increased risk of At increased risk of obstruction obstruction Large headLarge head Short neckShort neck Small oral cavitySmall oral cavity Large tongueLarge tongue <6mths nasal <6mths nasal

breathersbreathers

Airway - managementAirway - management

Neutral position in Neutral position in infantsinfants

SuctionSuction Jaw thrustJaw thrust Adjuncts Adjuncts

BreathingBreathing

Respiratory FailureRespiratory Failure

Leading Cause of Pediatric Cardiac ArrestLeading Cause of Pediatric Cardiac Arrest

BreathingBreathing

Increased respiratory rateIncreased respiratory rate What is normal for 8 month old?What is normal for 8 month old?

• Slow rate = impending arrestSlow rate = impending arrest

AGE NORMAL RR

<1 YEAR 30-40

2-5 YEARS 25-30

5-12 YEARS 20-25

>12 YEARS <20

BreathingBreathing

3 Es:3 Es:• EffortEffort – grunting, RR, nasal flaring, – grunting, RR, nasal flaring,

recession, use of accessory musclesrecession, use of accessory muscles

• EfficacyEfficacy – chest expansion, breath – chest expansion, breath soundssounds

• EffectEffect – cyanosis, oxygen sats, mental – cyanosis, oxygen sats, mental statusstatus

BreathingBreathing

Trauma specific: Trauma specific: • contusions contusions • wounds wounds • subcutaneous subcutaneous

emphysemaemphysema

BreathingBreathing

Pliant chest wallsPliant chest walls Rib fractures rareRib fractures rare Pulmonary Pulmonary

contusions commoncontusions common

Breathing - managementBreathing - management

OxygenOxygen Ventilate / intubate if required Ventilate / intubate if required Analgesia Analgesia Treat pneumothorax if presentTreat pneumothorax if present

CirculationCirculation

Silence is not Silence is not GoldenGolden

CirculationCirculation

Small blood Small blood volumevolume

Good Good initialinitial compensation for compensation for hypovolemiahypovolemia

CirculationCirculation

BP monitoringBP monitoring Poor methodPoor method

To assess perfusion, check:To assess perfusion, check: Pulse rate, quality of peripheral pulsesPulse rate, quality of peripheral pulses Skin temperatureSkin temperature Capillary refillCapillary refill Level of consciousnessLevel of consciousness

Shock ManagementShock Management

Keep warmKeep warm Fluid Resuscitation-Fluid Resuscitation-

Volume weight basedVolume weight based ReassessReassess Repeat boluses as indicated by responseRepeat boluses as indicated by response

Special circumstancesSpecial circumstances

Head TraumaHead Trauma

Major cause of deathsMajor cause of deaths

Unfused sutures allow significant Unfused sutures allow significant intracranial haemorrhage which can lead intracranial haemorrhage which can lead to shockto shock

Scalp wounds can lead to anaemiaScalp wounds can lead to anaemia

Head TraumaHead Trauma

Key symptoms – headache, vomiting, Key symptoms – headache, vomiting, irritability or drowsinessirritability or drowsiness

Neurological examination varies with age - Neurological examination varies with age - Observation keyObservation key

Severe Head TraumaSevere Head Trauma

May need to intubate to scanMay need to intubate to scan Controlled ventilationControlled ventilation

Maintain normal BPMaintain normal BP

CPP = MAP - ICPCPP = MAP - ICP

Spinal TraumaSpinal Trauma

SCIWORA – Spinal cord injury withoutSCIWORA – Spinal cord injury without

radiographic abnormality radiographic abnormality X-rays and CT look normalX-rays and CT look normal Usually affects spineUsually affects spine Due to elasticity of spineDue to elasticity of spine Abnormalities now usually seen on MRIAbnormalities now usually seen on MRI

Abdominal TraumaAbdominal Trauma

Primarily bluntPrimarily blunt Organs are vulnerableOrgans are vulnerable Spleen, liver = Most common injuriesSpleen, liver = Most common injuries

High costal archHigh costal arch Relatively larger organsRelatively larger organs Poor abdominal muscle developmentPoor abdominal muscle development

Abdominal TraumaAbdominal Trauma

Contusions Contusions TendernessTenderness Unexplained hypovolemic shockUnexplained hypovolemic shock

Extremity TraumaExtremity Trauma

Never warrants attention before head, Never warrants attention before head, chest, abdomen injurychest, abdomen injury

Think of neurovascular supplyThink of neurovascular supply Evaluate distal extremity for:Evaluate distal extremity for:

Skin color, temperatureSkin color, temperature Motor, sensory functionMotor, sensory function Capillary refillCapillary refill PulsesPulses

BurnsBurns

Pediatric patientsPediatric patients 50% of burn admissions50% of burn admissions 33% of burn deaths33% of burn deaths

Challenges due toChallenges due to Immature immune systemImmature immune system Small airways – increased Small airways – increased

complicationscomplications Fluid and heat lossFluid and heat loss

REMEMBER IN ALL CASES REMEMBER IN ALL CASES

TO CONSIDERTO CONSIDER

POSSIBLE NON ACCIDENTAL POSSIBLE NON ACCIDENTAL INJURYINJURY

QuestionsQuestions

SummarySummary

Same PRIORITIES as treating adultsSame PRIORITIES as treating adults ABCsABCs

Neutral head position in infantsNeutral head position in infants Prone to intra-thoracic and abdominal Prone to intra-thoracic and abdominal

organ injuryorgan injury Will compensate until fall off cliffWill compensate until fall off cliff