17 - trauma in children.ppt

8/10/2019 17 - Trauma in Children.ppt

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trauma in children 17- 1

Chapter

XVII TRAUMA INCHILDREN


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Overview

Communications withchildren and parents

Equipment for managingpediatric patients

Assessment and management

Injury prevention


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Approach to thePediatric Patient

Be positive and choose wordscarefully.

Explain what you are doing and why

you are doing it. Particularly patient packaging

Use equipment appropriate for thepediatric patient.

Always do what is best for the patient.

Always be an advocate for the child.


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Parents

Communicate with parents & child.

Be confident and professional. Both in manner and dress

Try to involve parents in care of thechild.

Try not to separate family members.

Always do what is best for the patient.

Consider parents when treatingthe child.


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Equipment

Obtain appropriate equipment totreat pediatric patients.

Create a Pediatric Trauma Kit. Use Broselow tape to organize the

equipment.

Sort equipment by size and age.

Place copy of normal vital signs for age in

the top of the kit.


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Length-Based

Resusication Tapes


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Scene Size-up Falls most common mechanism.

Think head injury.

Motor vehicle collisions frequentlycause internal injuries.

Suspect abuse if: History does not match the injury.

Delay in seeking help.

Story keeps changing. Know your states EMS requirements

about reporting suspected abuse.


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Assessment Same as for other trauma patients

Scene Size-up

BTLS Primary Survey

Initial Exam

Rapid Trauma Survey vs. FocusedExam

Transport decision and Criticalinterventions

Ongoing Exam

Detailed Exam


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Normal Values:

RespirationNewborn 30-50

Infant 30-40 Older child 20-30

Respiration >40/min suggests

respiratory distress (except innewborns).


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Normal Values:

Heart RateNewborn 120-160

6 mo-1 yr 120-140

2-4 yrs 100-110 5-8 yrs 90-100

>8 yrs 80-100

Weak, rapid pulse with rate >130suggests shock in all exceptnewborns.


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Normal Values: Systolic

Blood PressureNewborn >60

6 mo-1 yr 70-80 2-4 years 80-90

5-8 years 90-100

8-12 years 100-110

>12 years 100-120


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Estimating Normal

Systolic BP 80 + (age in years x 2)

Systolic BP


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Airway ControlNeutral positionpad under shoulders

Jaw thrust

Oral airway Nasopharyngeal airway too small for children

Bulb suction Neonates obligatory nose breathers

Pediatric BVM Without pop-off valve

Appropriate size face mask


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Airway Control Use orotracheal intubation.

Endotracheal tube size:

About size of patients little finger

About size of external naresNo cuffed tubes until at least 6mm size

Size of tube = 4 + 1/4 age in years

Use length-based tape for correct size

tube.


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Circulatory Assessment

Level of consciousness

Heart rate

>130 suggests shock in all exceptnewborns

Blood pressure


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Advanced Procedures

Intubation and IVs are oftenvery difficult in the field.

If possible, delay advancedprocedures until you reach theemergency department.


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Shock Management

Rapid Assessment.

Airway with cervical spine control.

High-flow oxygen. Control bleeding.

Possible IV/IO access. 20cc/Kg bolus NS

Rapid transport.


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Head Injuries

Rapid Assessment.

Airway with cervical spine control.

High-flow oxygen.

Maintain blood pressure.

Prevent aspiration. Record GCS.

Consider intubation for 8 or less.

Most common cause of traumatic death

in children


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Chest Injuries

Rapid Assessment.

Rib fractures and flail chest rare.

Pneumothorax and pulmonarycontusion are common.

Signs of respiratory distress: Tachypnea (rate >40)

Grunting Nasal flaring

Retractions


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Abdominal Injuries

Blunt abdominal injury

Second leading cause of traumaticdeath in children.

Rapid Assessment.

Be prepared to treat for shock.

Shock shows up late in children.

Continual reassessment.


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Spinal Injuries Rare before adolescence but disastrous when

they occur.

Same indications for packaging as foradults.

Use a pad under the shoulder to keep theneck neutral.

Restrict movement of the head and neckwith cervical collar or other appropriate

device. Cervical collar not necessary if head is

properly motion-restricted.


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Child Restraint Seats The child with no

apparent injury may bepackaged andtransported in the seat.

The child with injuriesshould be removed andpackaged on a

backboard.


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Prevention Educate parents and children:

Use of car seats

Airbags

Use of seat belts

Water safety

Fire drills

Helmet use

ATVs

Airbags


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Summary Anticipate problems unique to

children.

Try not to separate children fromparents.

Know (or have available) normalvalues for children.

Have correct equipment.

Notify Medical Direction early.

Always be an advocate for the child.


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Questions?

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