Trauma (peds): Difference between revisions
 
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{{Peds top}} [[Trauma (main)]].''
==Background==
==Background==
*Key is to recognize and treat shock early (before blood pressure decreases),
*Key is to recognize and treat [[pediatric shock|shock]] early (before blood pressure decreases),
**once child has signs/symptoms of shock, may have lost 25% of blood volume
**once child has signs and symptoms of shock, may have lost 25% of blood volume
*BP not usually helpful sign of blood loss in peds
*BP not usually helpful sign of blood loss in pediatric patients
**Kids more effective at increasing HR and stroke volume, so can have high, low, or normal BP in shock
**Can have high, low, or normal BP in shock
**pulse pressure is helpful
**pulse pressure is helpful
*80% of peds trauma deaths associated with neurological injury (see HCT/Head trauma memo)
*80% of pediatric trauma deaths associated with neurological injury (see [[pediatric head trauma]])
 
{{Locations of Possible Life-Threatening Bleeding}}
{{Pediatric car seat rules}}


==Clinical Features==
==Clinical Features==
*Peds triad is appearance, work of breathing & circulation (skin color)
*Peds assessment triad: appearance, work of breathing & circulation (skin color)
*Childs size allows for dist of injuries, thus mutliple trauma is common & internal organs more susceptible to injury d/t more ant placement of liver & spleen (& less protective muscle & fat), Kidenys also less well protected and more mobile=more prone to decel injury
*Child's size allows for distribution of injuries
*Wadell Triad in auto/ped= CHI, abd inj, femur fracture
**multi-system trauma is common
**internal organs more susceptible to injury due to anterior placement of liver and spleen (as well as less protective muscle & fat)
**Kidneys also less well protected and more mobile, prone to decelleration injury
*Wadell Triad in auto vs. pedestrian child= femoral shaft fracture, intraabdominal/intrathoracic injury, and contralateral head injury


==Differential Diagnosis==
==Differential Diagnosis==
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*[[Chance fracture]]
*[[Chance fracture]]


==Diagnosis==
==Evaluation==
*CT A/P
*[[FAST]] exam
**Significant intra-abdominal injury after blunt torso trauma highly unlikely (0.1%) if all of the following are true:
*Consider as indicated:
***Glasgow coma scale ≥14
**CBC, coags, T&S, [[LFTs]] for abdominal trauma<ref>The Utility of Laboratory Testing in Pediatric Trauma: A Primer from TAMING OF THE SRU Dec 13, 2019 available at  http://www.tamingthesru.com/blog/grand-rounds/diagnostics/labs-in-peds-trauma</ref>
***No evidence of abdominal wall trauma or seat belt sign
**Plain films
***No abdominal tenderness
**[[CT head]], [[cervical spine clearance]] clinically or with imaging
***No complaints of abdominal pain
**CT abdomen/pelvis<ref>Holmes JF et al. Identifying Children at Very Low Risk of Clinically Important Blunt Abdominal Injuries. Ann Emerg Med. 2013</ref>
***No vomiting
***Significant intra-abdominal injury after blunt torso trauma highly unlikely (0.1%) if all of the following are true:
***No thoracic wall trauma
****Glasgow coma scale ≥14
***No decreased breath sounds
****No evidence of abdominal wall trauma or seat belt sign
****No abdominal tenderness, abdominal pain, or vomiting
****No thoracic wall trauma or decreased breath sounds


==Management==
==Management==
*[[ATLS]]
*[[ATLS]]
*In ED give IVF @ 20cc/kg, if unresponsive after 40cc/kg give PRBC @ 10cc/kg (can start w/ PRBC if presents in decompensated shock & multip inj suspected)
*In ED give [[IVF]] at 20cc/kg, if unresponsive after 40cc/kg give [[PRBCs]] at 10cc/kg (can start with PRBC if presents in decompensated shock & multiple injuries suspected)


==Disposition==
==Disposition==
*Depends on underlying injury


==See Also==
==See Also==
*[[Pediatric head trauma]]
*[[Pediatric head trauma]]
**[[PECARN head trauma rule]]
*[[Trauma (main)]]
*[[Trauma (main)]]
==External Links==
*[http://pemplaybook.org/podcast/multisystem-trauma-in-children-part-one-airway-chest-tubes-and-resuscitative-thoracotomy/ Pediatric Emergency Playbook Podcast -- Multisystem Trauma in Children Part One: Airway, Chest Tubes, and Resuscitative Thoracotomy]
*[http://pemplaybook.org/podcast/multisystem-trauma-in-children-part-two-massive-transfusion-trauma-imaging-and-resuscitative-pearls/ Pediatric Emergency Playbook Podcast -- Multisystem Trauma in Children Part Two: Massive Transfusion, Trauma Imaging, and Resuscitative Pearls]


==References==
==References==
*Holmes JF et al. Identifying Children at Very Low Risk of Clinically Important Blunt Abdominal Injuries. Ann Emerg Med. 2013
<references/>


[[Category:Pediatrics]]
[[Category:Pediatrics]]
[[Category:Trauma]]
[[Category:Trauma]]

Latest revision as of 19:16, 3 August 2022

This page is for pediatric patients. For adult patients, see: Trauma (main).

Background

  • Key is to recognize and treat shock early (before blood pressure decreases),
    • once child has signs and symptoms of shock, may have lost 25% of blood volume
  • BP not usually helpful sign of blood loss in pediatric patients
    • Can have high, low, or normal BP in shock
    • pulse pressure is helpful
  • 80% of pediatric trauma deaths associated with neurological injury (see pediatric head trauma)

Locations of Possible Life-Threatening Bleeding

Pediatric car seat rules[1]

Age Type of Car Seat Position Comments
<2 years old Infant-only or convertible car seat Back seat, rear-facing If child height or weight > seat limit (usually ~40-65lbs), go to next age up
2-8 years old Convertible or combination car seat Back seat, forward-facing If child height or weight > seat limit, go to next age up
8-12 years old Booster seat Back seat, forward-facing If child height or weight > seat limit (usually 4' 9"), go to next age up
12-13 years old Lap and shoulder seat belt Front or back seat, forward-facing

Clinical Features

  • Peds assessment triad: appearance, work of breathing & circulation (skin color)
  • Child's size allows for distribution of injuries
    • multi-system trauma is common
    • internal organs more susceptible to injury due to anterior placement of liver and spleen (as well as less protective muscle & fat)
    • Kidneys also less well protected and more mobile, prone to decelleration injury
  • Wadell Triad in auto vs. pedestrian child= femoral shaft fracture, intraabdominal/intrathoracic injury, and contralateral head injury

Differential Diagnosis

Evaluation

  • FAST exam
  • Consider as indicated:
    • CBC, coags, T&S, LFTs for abdominal trauma[2]
    • Plain films
    • CT head, cervical spine clearance clinically or with imaging
    • CT abdomen/pelvis[3]
      • Significant intra-abdominal injury after blunt torso trauma highly unlikely (0.1%) if all of the following are true:
        • Glasgow coma scale ≥14
        • No evidence of abdominal wall trauma or seat belt sign
        • No abdominal tenderness, abdominal pain, or vomiting
        • No thoracic wall trauma or decreased breath sounds

Management

  • ATLS
  • In ED give IVF at 20cc/kg, if unresponsive after 40cc/kg give PRBCs at 10cc/kg (can start with PRBC if presents in decompensated shock & multiple injuries suspected)

Disposition

  • Depends on underlying injury

See Also

External Links

References

  1. ↑ AAP 2011. http://pediatrics.aappublications.org/content/pediatrics/early/2011/03/21/peds.2011-0213.full.pdf
  2. ↑ The Utility of Laboratory Testing in Pediatric Trauma: A Primer from TAMING OF THE SRU Dec 13, 2019 available at http://www.tamingthesru.com/blog/grand-rounds/diagnostics/labs-in-peds-trauma
  3. ↑ Holmes JF et al. Identifying Children at Very Low Risk of Clinically Important Blunt Abdominal Injuries. Ann Emerg Med. 2013
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