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Explore historical context, guidelines, and practical strategies for fluid resuscitation in pediatric trauma. Learn the importance of restoring volume correctly to avoid complications. Expert insights and hands-on advice for better patient outcomes.
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Pediatric Fluids In Trauma Tom Poulton M.D.
The Challenge • “They are not just little adults!”
What we shall cover • Historical Context • Stereotypes • The “Research” • ATLS and Others • Practical Guidelines
My background • Peds Anesthesiologist • Peds Intensivist • 30 years Level I Trauma Centers • PALS Instructor • PALS Instructor • Medical Director Urban EMS Programs • Medical Director Flight Program • U.S. Navy Field Hospital
Fluid Resuscitation • Curious phrase?
Resuscitation • Origins • Why “fluid resuscitation”?
Historical Evolution • Don’t give kids too much • Give ‘em more • That’s it • No, not that much
Ask a Pro • “Well, in general, non-experts are too stingy with fluids in trauma patients”
Fair Question • So, do you want us to give too much or too little?
What is the Goal? • Restore circulating blood volume • Restore aerobic metabolism • Avoid organ injury
Restoring Volume • Fluids are cheap. Why not be generous?
Restoring Volume--Downsides • Dilution • Coagulation • Edema where we don’t want it • …and worse stuff
How We Die? • Acidosis
What are we designed to tolerate? • Acidosis
Target • Not too much • Not too little • Just right…
Gimme a break!! • What’s the standard?
Standards • ATLS • European Union • Australian Trauma Society • Norwegian Trauma Alliance • My Uncle Fred
Practical Norwegians • Treat until you have a periph pulse • Nl BP minus 20% if no TBI • Nl BP if TBI
Starting Point • How much? • Who needs more than 20ml/kg?
General Consensusas of this morning… • Healthy kids compensate well • Any Drop in BP: Probably > 30% BV
Uh, is the BP low?? • Depends on knowing what normal BP is. • That may depend on knowing about what the age is. • Broselow tape may help. • Better have atable of normal BPs.
What can I rely on?? • Cap refill • The Gestalt • This is not rocket science
Some Practical Stuff • Venous Access • Two large-bore IVs • Intraosseous • Central Lines • Swoop and Scoop • Stay and Play
Bottom Line • Bleeding is a surgical problem. • Surgery fixes ongoing bleeding. • Extra IVs don’t help much. • Extra time at the scene doesn’t help much. • Ten minutes at the scene won’t help anything. • Knowing the immunization history isn’t going to help.