Trauma (peds): Difference between revisions
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*[[Pediatric head trauma]] | *[[Pediatric head trauma]] | ||
*[[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== | ||
Revision as of 16:07, 20 December 2016
Background
- Key is to recognize and treat shock early (before blood pressure decreases),
- once child has signsigns and symptomsymptoms of shock, may have lost 25% of blood volume
- BP not usually helpful sign of blood loss in peds
- Kids more effective at increasing HR and stroke volume, so 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)
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
- CT A/P
- 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
- No complaints of abdominal pain
- No vomiting
- No thoracic wall trauma
- No decreased breath sounds
- Significant intra-abdominal injury after blunt torso trauma highly unlikely (0.1%) if all of the following are true:
Management
- ATLS
- In ED give IVF at 20cc/kg, if unresponsive after 40cc/kg give PRBC at 10cc/kg (can start with PRBC if presents in decompensated shock & multip injuries suspected)
Disposition
See Also
External Links
- Pediatric Emergency Playbook Podcast -- Multisystem Trauma in Children Part One: Airway, Chest Tubes, and Resuscitative Thoracotomy
- Pediatric Emergency Playbook Podcast -- Multisystem Trauma in Children Part Two: Massive Transfusion, Trauma Imaging, and Resuscitative Pearls
References
- Holmes JF et al. Identifying Children at Very Low Risk of Clinically Important Blunt Abdominal Injuries. Ann Emerg Med. 2013