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
– – – – 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
– – – – 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