Trauma in Special Populations: Pediatrics

1. 41 Trauma in Special Populations: Pediatrics

2. Objectives • Discuss the incidence of pediatric trauma and death. • Identify disease patterns and assessment findings common to pediatric trauma. • Review “organ-specific care” that is integral to pediatric trauma management.

3. Introduction • Children have unique anatomic and physiologic characteristics. • They are more likely to suffer multi-organ system involvement. • Unrecognized trauma leads to higher morbidity and mortality than in adults. • Advanced EMTs must appropriately recognize and adequately treat pediatric trauma patients.

4. Epidemiology • Over 300,000 pediatric hospitalizations a year are due to trauma. • 40% of injuries are sustained from motor vehicle trauma. • Pediatric trauma patients continue to have the worst outcomes during resuscitation.

5. Trauma Scoring Systems • Functions of Systems • Tool for triage and treatment decisions • Tool for predicting the severity of the illness or mortality • Most widely used is Glasgow Coma Scale

6. Pediatric Glasgow Coma Scale

7. Pediatric Glasgow Coma Scale

8. Pediatric Glasgow Coma Scale

9. Assessment and Care • Anatomical and Physiologic Differences • Airway, oxygenation, and ventilation • Smaller midface • Larger tongue • Narrow nares and lower airways • Glottic opening higher and anterior • Short neck

10. Assessment and Care (cont’d) • Anatomical and Physiologic Differences (continued) • Breathing • If GCS is less than 12, the patient may need assistance. • Hyper- and hypoventilation have been implicated in poorer outcomes upon arrival at ED. • Use age-appropriate rate for ventilation. • Inflate just enough to see the chest rise.

11. Assessment and Care (cont’d) • Anatomical and Physiologic Differences (continued) • Circulation • Blood volume varies by age. • Infants have 100 mL/kg, adults have 50 mL/kg. • Minimal blood loss can precipitate hypoperfusion syndrome.

12. Assessment and Care (cont’d) • Anatomical and Physiologic Differences (continued) • Circulation • Indications of hypoperfusion include tachycardia, poor peripheral perfusion, altered mental status, poor muscle tone. • Obtain IV access and administer up to three 20 mL/kg boluses based on patient presentation.

13. Assessment and Care (cont’d) • Organ-Specific Care • Cerebral blood flow • An acutely injured brain is susceptible to any other blood disturbance • Delivery of oxygen and removal of waste must be ongoing. • The need for maintaining normoxia and normocarbia is imperative

14. Assessment and Care (cont’d) • Organ-Specific Care (continued) • Head, neck, spine • Waddell triad • Head injuries and brain injuries are implicated in 80% of pediatric trauma deaths. • Remain acutely aware of mental status. • Maintain normothermia. • Immobilization may need to be modified.

15. Assessment and Care (cont’d) • Organ-Specific Care (continued) • Chest • Delayed ossification of ribs. • Energy is transmitted to organs. • Twice as likely to sustain thoracic or abdominal organ trauma.

16. Assessment and Care (cont’d) • Organ-Specific Care (continued) • Multi-organ system trauma • Injuries most highly associated with death are cardiac tamponade (70%), hemothorax (50%), cardiac injury (48%), injury to aorta (42%), flail chest (40%), and tension pneumothorax (39%).

17. Assessment and Care (cont’d) • Organ-Specific Care (continued) • Abdomen and pelvis • Internal hemorrhage from the liver or spleen can kill the child quickly. • Abdominal distention inhibits diaphragm motion. • Bleeding may also occur, like adults, from pelvic trauma.

18. Assessment and Care (cont’d) • Organ Specific Care (continued) • Skeletal injuries • The younger the patient, the more flexible the bone and the harder it is to break it. • Toddlers are the youngest patients in whom accidental fractures are seen. • Trauma in infants is often inflicted by others.

19. Summary • Pediatric patients are often problematic for care providers due to anatomical differences, equipment need differences, and lack of exposure.

20. Summary (cont’d) • Apprehension that comes from dealing with pediatrics needs to be eliminated. Uncertainty, poor skill, or inadequate judgment on the Advanced EMT's part can be fatal to the pediatric patient.