Pediatric Trauma
Temple College
EMS Professions
Pediatric Trauma
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#1 killer after neonatal period
Priorities same as in adults
ABC’s
Children are not just little adults!
Airway
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Anatomy increases upper airway
obstruction risk
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Large head
Short neck
Small mandible
Large, posteriorly placed tongue
Children do NOT mouth breathe well
Airway
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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
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Small passages obstruct easily
Horizontal ribs, weak accessory
muscles = Poor respiratory reserve
Swallowed air may limit ventilations
Anticipate need to assist ventilation
Breathing
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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
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High metabolic rates + Low reserve
capacity = High sensitivity to airway,
breathing problems
Oxygenate, ventilate aggressively
Circulation
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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
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BP monitoring = Poor shock indicator
Assess perfusion using:
– Peripheral pulse rate, quality
– Skin color, temperature
– LOC (Silence is not Golden)
– Capillary refill
Management
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Airway
100 % O2
Consider early ventilation
Prevent hypothermia
– Large surface/volume ratio =
increased heat loss
– Cover with blanket
Head Trauma
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Major cause of death
– Large heads
– Thin skulls
– Poor muscle control
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Diffuse edema more common than
intracranial hematomas
Head Trauma
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Monitor for signs of increased ICP
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AVPU
Pupils
Vomiting
Cushing’s triad
Hyperventilate
Resuscitate hypovolemic shock aggressively
Spinal Trauma
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Uncommon
– Usually occur at C1, C2, C3 (high C-spine)
– Dislocations more common than fractures
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Suspect if trauma involves:
– Sudden deceleration
– Head injuries
– Decreased LOC
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Resist temptation to pick child up and run!
Chest Trauma
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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
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Mobile mediastinum
– Poor tension pneumothorax tolerance
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Limited respiratory reserve
– Poor chest injury tolerance
Abdominal Trauma
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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
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Tenderness = Significant trauma
until proven otherwise
Distension = Significant trauma until
proven otherwise
Extremity Trauma
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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
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Children account for:
– 50% of burn admissions
– 33% burn deaths
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Large body surface area increases:
– Fluid loss
– Heat loss (hypothermia risk)
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Smaller airway
– Increased obstruction risk
Burns
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Consider possibility of child abuse:
– Story does not match pattern of burn
– “Stocking” or “glove” injury
– Unusually deep burns