Pediatric Trauma
The Bumps & Bruises of Growing Up
Trauma
- #1 killer of children after neonatal period
- 50% of childhood deaths
Pediatric Trauma
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Same priorities as adults
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ABC’s first
Airway
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Anatomy increases obstruction risk
–Large head
–Short neck
–Small mandible
–Large, posteriorly-placed tongue
Airway
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Poor, absent mouth breathing ability
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Neck over-extension: obstruction secondary to high glottis
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Good anterior jaw displacement important
Airway
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ET tubes wind up in right mainstem
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Secure intubated chil d’s head in neutral position; avoid extubation
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Pass gastric tube early; decompress stomach
Breathing
Increased respiratory rate
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30/min = ? normal for small child
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Slowing rate = impending arrest
Breathing
Small thorax
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Transmitted breath sounds
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Misleading findings on auscultation
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Inspection, palpation more reliable

Breathing
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Diaphragm breathers
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Pliant chest walls
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Weak accessory muscles
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Limited respiratory reserve
Breathing
- Respiratory Failure
- Leading Cause of Pediatric Cardiac Arrest
Circulation
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Small blood volume
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Rapid control of blood loss essential
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Good initial compensation for hypovolemia
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“Sudden” onset of irreversible shock
Circulation
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BP monitoring
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Poor method
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To assess perfusion, check:
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Rate, quality of peripheral pulses
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Skin color, temperature
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Capillary refill
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Level of consciousness
Circulation
- Silence is not Golden
Shock Management
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100% Oxygen
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Assist ventilation as needed
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Keep warm
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MAST
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Legs only initially
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If abdomen needed, intubate/ventilate
Shock Management
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Fluid Resuscitation
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LR or NS in 20cc/kg boluses
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Reassess, reassess, reassess
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Repeat boluses as indicated by response
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Warm fluids if possible
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Gastric tube placement

Head Trauma
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Major cause of pediatric trauma deaths
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Intracranial hematomas less common
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Diffuse axonal injury, edema more common
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Outcomes better than in comparably injured adults
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Treat aggressively
Head Trauma
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Evaluate for increased ICP
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AVPU
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Pupils
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Vomiting
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Dysconjugate eye movement
– Cushing’s response
Head Trauma
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Control airway
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Protect cervical spine
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Controlled Ventilations
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Upper end of normal
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Ensure adequate shock resuscitation
Spinal Trauma
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Rare in pediatric patients
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Usually high C-spine dislocation
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C-1, C-2
Spinal Trauma
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Suspect in same situations as adult
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Sudden deceleration
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Head, face injuries
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Decreased LOC in trauma
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Absence of good history
Spinal Trauma
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If you think about spinal immobilization, do it!!
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Resist temptation to pick up child, run

Chest Trauma
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Second leading cause of death after head trauma
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Primarily blunt
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High incidence of associated head, extremity injury
Chest Trauma
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Pediatric thoracic wall pliant
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Rib fracture, flail chest rare
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Severe intrathoracic trauma can occur without fracture
Chest Trauma
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Limited respiratory reserve
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Trauma poorly tolerated
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Recognize, intervene early
Abdominal Trauma
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Most common form
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Primarily blunt
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Spleen, liver = Most common injuries
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High, broad costal arch
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Relatively larger organs
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Poor abdominal muscle development
Abdominal Trauma
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Mechanism of injury
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Unexplained hypovolemic shock
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Tenderness
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Increased abdominal girth
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Intra-abdominal hemorrhage until proven otherwise
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Could be gastric distension
Extremity Trauma
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Never warrants attention before head, chest, abdomen injury
Extremity Trauma
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Most common complication = neurovascular injury
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Especially common in supracondylar areas of humerus, femur

Extremity Trauma
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Evaluate distal extremity for:
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Pulses
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Skin color, temperature
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Motor, sensory function
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Capillary refill
Extremity Trauma
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Unique injuries
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Greenstick fracture
•Tenderness, edema, guarding, inconsolable crying = fracture until proven otherwise
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Epiphyseal plate fracture
•Injuries near bone ends
•? Growth problems
Burns
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Pediatric patients
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50% of burn admissions
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33% of burn deaths
Burns
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Large body surface area increased
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Fluid loss
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Heat loss
Burns
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Immature immune system
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Increased infection complications
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Small airways
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Decreased respiratory reserve
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Increased complications of airway burns
Burns
- Pediatric Burns
- Possible Child Abuse