Trauma (peds)
Revision as of 05:22, 26 July 2016 by Neil.m.young (talk | contribs) (Text replacement - "==Diagnosis==" to "==Evaluation==")
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 peds 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 @ 20cc/kg, if unresponsive after 40cc/kg give PRBC @ 10cc/kg (can start with PRBC if presents in decompensated shock & multip inj suspected)
Disposition
See Also
References
- Holmes JF et al. Identifying Children at Very Low Risk of Clinically Important Blunt Abdominal Injuries. Ann Emerg Med. 2013