Pitfalls in Paediatric Resuscitation

Brian Burns @HawkmoonHEMS

www.resus.me/swan24

AXIOMATIC

Kids are little adults

Severe TBI and haemorrhage

TOP

KILLERS

in

TRAUMA

Severe TBI

EARLY hypotension(PH/ED): SBP <5% centile = very bad

Hypoxia, hypercarbia = bad

Errors of OmissionCognitive overload

high performanceconsistencyfamiliarity

HaemorrhageDCR

Early products- ideal = whole blood

Haemostatic resuscitation

Minimising crystalloid

Avoid over-resuscitation

Avoid supernormal MAP

Rapid haemorrhage control

ATCShock Hypoperfusion

Coagulopathy?

Plasma-based lab tests

PT,aPTT, INR, fibrinogen, plt

poor clinical correlation

retrospective

Predefined MTP

TXA

< 3 hrs from injury

Who? : ATC/high risk ATC

15mg/Kg over 1 hr then 2mg/kg/hr over 8 hours

Transfusionsvolume overload

electrolyte disturbance

dilutional coagulopathy if not balanced

haemolysis

TRALI

MOF

PREDEFINED MTP=less MOF, infection, ventilation, mortality

SHOCK

Paediatric age-adjusted SI

Lactate >4

NARROW pulse pressure

InterventionsSAME indications as adults

Do it!

Resuscitative thoracotomy

Penetrating TCA <10min loss SOL or loss SOL in ED

Blunt TCA without SOL in ED unsalvageable

Logistics

Analgesia

Avoid oligoanalgesia

Subdissociative ketamine

Intranasal fentanyl

Kids are not little adults

• larger heads

• less fat

• more exposed solid organs

• pliable skeleton=

• force transmission

Injury Pattern

MVC/Pedestrian

Falls

Low penetrating

Physiology

hypovolaemia masked by reserve and compensation until >20% BV loss

high BMR= high O2 consumption

higher BSA to weight= hypothermia

Psychosocial

Behaviour regresses by 5 years

Parents in the resus room

Radiology

Focused CT. ALARA principle

eFAST ?

Non-operative critical care

Close observation v surgery

Trauma deaths

process

safeguard the future performance of team + system

Kids should sometimes be treated like little adults and sometimes they should not

Knowing when is the key