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An introduction to … Paediatric Trauma

An introduction to … Paediatric Trauma. Objectives. Who What Where When How Why. Who/what are children?. Loud, energetic Humans …small humans B rothers, S isters Sons, Daughters Aunts, Uncles, Nieces, Nephews Friends, Neighbours.

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An introduction to … Paediatric Trauma

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  1. An introduction to…Paediatric Trauma

  2. Objectives • Who • What • Where • When • How • Why

  3. Who/what are children? • Loud, energetic • Humans…small humans • Brothers, Sisters • Sons, Daughters • Aunts, Uncles, Nieces, Nephews • Friends, Neighbours Don’t switch off just yet…it’s not all emotive & gushy!

  4. Is Paediatric Trauma Common?? NO • 2012, England & Wales: 737 severely injured • Severe morbidity and mortality • Road traffic collisions • Head injuries

  5. Who sees Paediatric Trauma? 88% of traumatically injured children did not present to a MTC 26% of traumatically injured children are driven/ take public transport to ED

  6. WHAT • What injuries? • What severity? • What mechanism?

  7. Age predicts mechanism…mechanism predicts injury

  8. Age predicts mechanism…mechanism predicts injury • Under 1 – HEAD • 1 – 5 = EXTREMITIES • Older…

  9. WHEN • When will these children present?

  10. WHEN? i.e. out-of-hours, but rarely late PM/ early AM

  11. WHERE • Where do traumatically injured children present?

  12. WHERE DO THEY PRESENT? 88% of traumatically injured children did not present to a MTC 26% of traumatically injured children are driven/ take public transport to ED

  13. HOW • How to manage the injured child? • How to image the child? • How have the guidelines changed? • How to transfer the critically injured child?

  14. Guidelines • APLS • Royal College of Radiologists • Others

  15. The trauma approach • Cervical collars??? • MILS • Blocks & tapes • VacMat • Spinal board vs. scoop mattress???

  16. The alphabet starts with C? Student “I would assess the airway, breathing….” Instructor “Your patient bled out whilst you looked, listened & felt for breathing...they are now not breathing”

  17. But I can’t get access!! • Another operator • External jugular • IO • Femoral • Cut-down (saphenous) (scalp in babies)

  18. Resuscitation fluids • Blood (if available) • Blood/ Platelets/ FFP (if available) - 1:1:1 ratio • Crystalloid • 10ml/kg bolus • Reassess frequently

  19. Not just blood for bleeding Tranexamic acid • Adults: CRASH-2 study • Paeds: Cardiac/ scoliosis/ craniofacial surgery • Pragmatic dosage schedule – 15mg/kg loading dose (max 1g) over 10 minutes • Infusion of 2mg/kg per hour

  20. D is for disability • GCS • AVPU • AVPainU

  21. Neurology • Log roll no more - 20 degree tilt • Normothermia • Remember Glucose

  22. Imaging the injured child • APLS vs. RCR • Pan-scan CT?? • “FAST scan” US??

  23. What else is in? • Pelvic splints • Thomas splints • Kendrick splints

  24. HOW • HOW to transfer the (critically) injured child

  25. Before you move • Tertiary survey • What have you (we) missed?

  26. WHY • Why…

  27. WHY don’t we talk about..

  28. The elephant in the room • TARN DATA Jan 2004 – Dec 2013 • 14 845 children: 92.3% accidental injury • 368 as alleged assault (2.5%, CI 2.2% to 2.7%) • 769 as SCA (5.2%, CI 4.8% to 5.5%). Suspected child abuse • 751 of 769 (97.7%) occurred in the age group of 0– 5 years • 76.3% in infants under the age of 1 year. Suspected victims of abuse • Higher overall injury severity scores • Higher proportion of head injury • Threefold higher mortality rate of 7.6% (CI 5.51% to 9.68%) vs 2.6% (CI 2.3% to 2.9%).

  29. Non-accidental injury Remember • Consider NAI • Involve the right people • Recognise potential risk to others

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