Trauma (peds)

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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 pediatric patients
    • 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 pediatric trauma deaths associated with neurological injury (see pediatric head trauma)

Pediatric car seat rules[1]

Age Type of Car Seat Position Comments
<2 years old Infant-only or convertible car seat Back seat, rear-facing If child height or weight > seat limit (usually ~40-65lbs), go to next age up
2-8 years old Convertible or combination car seat Back seat, forward-facing If child height or weight > seat limit, go to next age up
8-12 years old Booster seat Back seat, forward-facing If child height or weight > seat limit (usually 4' 9"), go to next age up
12-13 years old Lap and shoulder seat belt Front or back seat, forward-facing

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

  • Consider:

CT abdomen/pelvis[2]

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

Management

  • ATLS
  • In ED give IVF at 20cc/kg, if unresponsive after 40cc/kg give PRBC at 10cc/kg (can start with PRBC if presents in decompensated shock & multip injuries suspected)

Disposition

  • Depends on underlying injury

See Also

External Links

References

  1. AAP 2011. http://pediatrics.aappublications.org/content/pediatrics/early/2011/03/21/peds.2011-0213.full.pdf
  2. Holmes JF et al. Identifying Children at Very Low Risk of Clinically Important Blunt Abdominal Injuries. Ann Emerg Med. 2013

Authors:

Ross Donaldson