Pediatric Trauma

Pediatric Trauma Tintinalli Chapter 252

Epidemiology • Leading cause death / disability < 1 yr. • #1MVA

Trauma Resuscitation Priorities • Same as adults • AcBCDE

Prehospital Considerations • Minimize scene time • IV rates >93% • ET rates 57 – 79%

Postresuscitation Priorities • Secondary survey • Head to toe • X-rays • Keep family with child if possible • Stabilize • Refer to specialty center

Specific Pediatric Injuries • Head trauma • Head big in small children • Similar symptoms to children • Increased ICP • Manitol • Post traumatic seizures • Uncommon 5% • Radiology • CT or MRI

Spinal Trauma • Uncommon in young children • Increased flexibility in young • SCIWORA possible • Clinical • Radiography • NEXUS • Management

Chest Trauma • Compliant chest walls • Standard AP CXR • Rib fracture most sensitive indicator

Abdominal Trauma • Physical examination may be misleading • DPL replaced by CT

Splenic Trauma • Most commonly injured organ in children

Hepatic Trauma • Second most commonly injured in chidren

Pancreatic Trauma • Uncommon

Bowel Trauma • <5% of children with blunt injuries • #1: Jejunum • #2: Ileum • #3: Cecum • Duodenum prone to hematoma • Seatbelt cause <5% of admitted trauma • Higher when belt incorrectly applied

Pelvic and GU Trauma • Uncommon in children • Consider with • Pelvic fracture • Flank injury • Back or groin injury • Straddle injuries • Urethral injury • Pubic fracture • Testicular injuries • Labial or scrotal injuries

Journal Article

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Pediatric Trauma