Trauma (peds)
This page is for pediatric patients. For adult patients, see: Trauma (main).
Background
- Key is to recognize and treat shock early (before blood pressure decreases),
- once child has signs and symptoms of shock, may have lost 25% of blood volume
- BP not usually helpful sign of blood loss in pediatric patients
- 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)
Locations of Possible Life-Threatening Bleeding
- External
- Internal
- Thoracic cavity
- Peritoneal cavity
- Retroperitoneal space (i.e. pelvic fracture)
- Femur fracture (into muscle/subcutaneous tissue)
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
- FAST exam
- Consider as indicated:
- CBC, coags, T&S, LFTs for abdominal trauma[2]
- Plain films
- CT head, cervical spine clearance clinically or with imaging
- CT abdomen/pelvis[3]
- 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, abdominal pain, or vomiting
- No thoracic wall trauma or 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 at 20cc/kg, if unresponsive after 40cc/kg give PRBCs at 10cc/kg (can start with PRBC if presents in decompensated shock & multiple injuries suspected)
Disposition
- Depends on underlying injury
See Also
External Links
- Pediatric Emergency Playbook Podcast -- Multisystem Trauma in Children Part One: Airway, Chest Tubes, and Resuscitative Thoracotomy
- Pediatric Emergency Playbook Podcast -- Multisystem Trauma in Children Part Two: Massive Transfusion, Trauma Imaging, and Resuscitative Pearls
References
- ↑ AAP 2011. http://pediatrics.aappublications.org/content/pediatrics/early/2011/03/21/peds.2011-0213.full.pdf
- ↑ The Utility of Laboratory Testing in Pediatric Trauma: A Primer from TAMING OF THE SRU Dec 13, 2019 available at http://www.tamingthesru.com/blog/grand-rounds/diagnostics/labs-in-peds-trauma
- ↑ Holmes JF et al. Identifying Children at Very Low Risk of Clinically Important Blunt Abdominal Injuries. Ann Emerg Med. 2013