Assessment and initial management of pediatric trauma patient
Aim: The trainee should have an understanding of overall management of the pediatric trauma
patient.
Objectives:
The trainee should have acquired the following knowledge:
 Define principles of team approach to the management of a child with trauma
 Understand the importance of mechanisms and patterns of injury in children with trauma
 Recognize unique anatomic features of trauma in children
 Recognize unique physiologic features of trauma in children
 Define priorities in the management of children with trauma
 Understand triage principles in the management of victims of trauma, including the rationale
for and application of scoring systems such as the Injury Severity Score and Revised Trauma
Score.
 Understand the importance of thermal environment in the management of children with
trauma
 Define a proper trauma history
 Recognize patterns of injury suggesting non-accidental trauma (abuse)
 Understand the impact of trauma on the development of children: physically, emotionally
and mentally
 Understand the importance of early rehabilitative services in the outcome of a childhood
trauma victim
 Understand the impact that trauma has on both the parents and families, and how it affects
their social situation
 Understand the importance and appropriate timing of parental presence in the trauma room
 Recognize the importance of injury prevention strategies, and understand their value as a
pediatric advocacy issue
 Recognize the importance of an organized and step-wise approach to trauma assessment and
management in patients with major multiple trauma
 Know how to proceed with a proper primary survey
 Recognize airway obstruction in children with major multiple trauma
 Anticipate the risk of cervical spine injury associated with major multiple trauma
 Understand that cervical cord injury can occur in the absence of radiological
abnormality
 Understand causes of acute cardiorespiratory collapse following major multiple
trauma
 Distinguish causes of shock based on clinical findings
 Understand methods of rapid assessment of the central nervous system and the
patient’s level of consciousness
 Understand that full exposure of the patient is essential to trauma management
 Recognize the importance of control of the thermal environment to the child with
major multiple trauma
 Recognize the difference between a life threatening injury and a limb threatening
injury
 Trauma resuscitation
 Plan the management of a child with an obstructed airway
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Understand the risks of delayed airway management in a child with respiratory
insufficiency
 Understand cervical spine alignment and the need for cervical spine
immobilization
 Understand indications for assisted ventilation in a traumatized child
 Understand principles of assisted ventilation
 Define the components of rapid-sequence intubation, including indications,
contraindications and complications of the procedure
 Identify shock and define appropriate fluid therapy for patients in shock
 Define options for vascular access, including peripheral and central venous, as
well as intraosseous access
 Understand the importance of external hemorrhage control in children with major
multiple trauma
 Define the indications, contraindications and complications for emergency
thoracotomy
 Understand the indications and contraindications for bladder catheterization
 Understand the indications and contraindications for gastric intubation
Know how to proceeds with an appropriate secondary survey
 Understand evaluation of the head and neck of a child with major multiple
trauma
 Understand evaluation of the cervical spine of a child with major multiple trauma
 Understand evaluation of the chest and respiratory system of a child with major
multiple trauma
 Understand evaluation of the heart and cardiovascular system of a child with
major multiple trauma
 Understand evaluation of the abdomen and gastrointestinal system of a child with
major multiple trauma
 Understand evaluation of the pelvis and genitourinary system of a child with
major multiple trauma
 Understand evaluation of the back and neurological system of a child with major
multiple trauma
 Understand evaluation of the extremities of a child with major multiple trauma
 Recognize the importance of immediate splinting and possible reduction of long
bone injuries in the management of children with major multiple trauma
Know the ancillary studies that can aid in the management on the pediatric trauma patient
 Recognize both the potential and pitfalls of early X-ray evaluation of the cervical
spine, chest and pelvis of a multiple trauma victim
 Prioritize the imaging of skeletal injuries in a multiple trauma victim
 Understand the role of initial laboratory studies in victims of major multiple
trauma
 Define the components of an initial trauma laboratory screen
 Understand the role of urinalysis in victims of major multiple trauma
 Understand the role of capnometry in the management of a child with major
multiple trauma
 Understand the role of ultrasonography in the management of a multiple trauma
victim
 Understand the role of computed tomography in the management of a child with
major multiple trauma
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Understand the role of angiography in the management of a child with major
multiple trauma
Understand the appropriate definitive care of pediatric trauma patients
 Understand the importance of early decisions regarding patient disposition
 Demonstrate ability to direct a trauma team during complex resuscitation
 Demonstrate ability to prioritize management decisions
 Demonstrate ability to coordinate consultants involved in the care of patients
with multiple trauma
Demonstrate appropriate use of analgesics and sedatives in patients with major multiple
trauma
Demonstrate appropriate use of antibiotics in patients with major multiple trauma
Demonstrate knowledge (indications, contraindications, complications) and ability (where
possible) to perform the following procedures:
 Endotracheal intubation
 Orogastric and nasogastric intubation
 Insertion of large bore peripheral and central venous lines
 Needle thoracostomy
 Tube thoracostomy
 Peritoneal lavage
 Local wound exploration
 Repair of simple and complex lacerations
 Splinting of extremity fractures
 Reduction and immobilization of joint dislocations
 Cricothyroidotomy
 Pericardiocentesis
 Resuscitative thoracotomy