Trauma (peds)

Background

• Key is to recognize and treat shock early (before blood pressure decreases),
  • once child has signs/symptoms 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 HCT/Head trauma memo)

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

• Standard trauma injuries plus:
• Child abuse
• SCIWORA
• Chance fracture

Diagnosis

• 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

Management

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

See Also

• Pediatric head trauma
• Trauma (main)

References

• Holmes JF et al. Identifying Children at Very Low Risk of Clinically Important Blunt Abdominal Injuries. Ann Emerg Med. 2013