Paediatric Trauma Patient

OVERVIEW

Apply ATLS/APLS protocol: primary survey to exclude life-threatening injuries, secondary survey, re-evaluation and definitive care.

GENERAL CONSIDERATIONS

• presentation: pedestrian, unrestrained passenger, HI, NAI, fall
• more abdominal injuries with multiple organs involved
• large head: increased chance of closed HI
• skeleton: pliable, internal organ damage with no fractures (pulmonary contusions, SCIWORA)
• surface area/volume ratio: at risk of hypothermia
• psychological: difficult historians, modified examination, investigations may require GA
• family: distressed parents and siblings
• consent issues
• equipment: adequate size/dose
• drugs: calculated to weight
• may require transfer to specialised paediatric center

AIRWAY DIFFERENCES

• large occiput -> passive flexion of c-spine (may require padding under chest)
• large amount of soft tissue in oropharynx -> visualisation of larynx more difficult
• larynx is funnel-shaped, more cephalad, anterior -> difficult to see cords
• tracheal short -> RMB intubation and accidental extubation common
• narrowest at the cricoid ring -> uncuffed tubes commonly used
• small diameter -> susceptible to airway obstruction
• small FRC + high O2 consumption -> desaturates quickly
• Guedel airway insertion: don’t rotate

BREATHING DIFFERENCES

• higher RR
• smaller VT
• higher risk of barotrauma

CIRCULATION DIFFERENCES

• increased reserves: can tolerate large volumes of blood loss and maintain BP
• tachycardia and poor skin perfusion may be only signs of shock with 45% loss of blood volume
• fluids: 3 x 20mL/kg crystalloid -> RBC 10mL/kg
• IV access: have low threshold for IO

DISABILITY

• modified GCS
• AVPU

EXPOSURE

• susceptible to hypothermia (high BSA:Wt ratio)