Pediatric Trauma 2014 Emergency Care Trauma Symposium

1. Pediatric Trauma2014 Emergency Care Trauma Symposium June 24, 2014 Michael Kim, MD

2. objectives • Epidemiology • Resources • Pediatric Assessment Triangle • Trauma approach • Destination: how and where?

5. Pediatric Trauma • Leading cause of death: 1-15 yr • 22 million injured / yr • 9.2 million ED visits • 20K deaths / yr • 50K permanent disabilities • Economic impact: $10,000,000,000 per year

8. Injury Prevention You can make a difference !

9. Resources for optimal prehospital care • Training • Equipment • Support and resources

10. EMS pediatric education / exposure • BLS training in pediatrics: 8 hrs • ALS training in pediatrics: 16 hrs • Percentage of pediatric runs: 10% • % of all pedsruns requiring ALS: 12 % • BMV: 1 in every 1.7 years • ETT: 1 in 3.3 years • IO placement: 1 in 6.7 years

11. Pediatric and trauma training

12. Pediatric and trauma training

14. Anatomy • Not just smaller • Bigger head • Airway • Musculoskeletal • Organ proportions • Greater surface to volume

16. EMSC Performance Measure 73 The percent of patient care units in the State/Territory that have the essential pediatric equipment and supplies as outlined in national guidelines. 2010 EMSC Program

17. EMSC Performance Measure 73 The percent of patient care units in the State/Territory that have the essential pediatric equipment and supplies as outlined in national guidelines. Wisconsin BLS PCUs: 57/203= 28% (National Average 23%) ALS PCUs: 81/353 = 23% (National Average 34%) 2010 EMSC Program

18. WI EMSC Pediatric Jump Kit

19. Resources

20. 9 y/o missing for 30 min • found face down next to rolled over ATV • no protective equipment • active hemorrhage from scalp • PNB at the scene

21. Approach to trauma patient • Airway • Breathing • Circulation • Disability • Exposure/Environment

23. Initial Assessment • Respiratory effort • Retraction • Rate • Nasal flaring • Grunting • Gasping • Abdominal breathing • Wheeze • Pulse oximetry • Endtidal CO2 • Airway • Normal speech & crying • Talking? • Crying? • Airway noises • Stridor • Appearance • AVPU • A &O • Confused • Irritable • GCS • Circulation • Heart rate • Hypotension • Mental status • Cyanosis • Pale • Cool to touch • Weak pulse • Poor capillary refill

24. Disability

25. Pediatric GCS

26. Intervention? • No resp effort • No pulse • Cyanotic • No movement

27. Interventions • Respiratory effort • Supplemental oxygen • PEEP • + pressure ventilation • Airway • Open airway • Jaw thrust (c-spine) • Oral airway • Maintainable? • Appearance • Stimulate • Interact • Support/console • Circulation • Stop hemorrhage • Temperature • Fluid resuscitation

28. Airway and Breathing

29. Circulation • assessment • intervention

30. Next • Disability (Dexi) • Glasgow Coma Scale (age appropriate) • Brief neurologic eval • Splint and immobilize • Exposure • Head to toe look see • Temperature control

31. Development and emotional • Age dependent abilities and understanding • Stranger anxiety • Crying • Attitude • Reaction to… • Intervention • Parental presence • No surprises • Distractions • Toys, bubbles, talking

32. Where to and how?

33. Trauma center FAQ • What is trauma center? • All resources available for severely injured pt • Levels I - IV • Why is trauma center important? • Mortality reduction 25% • Shorter length of stay • 24/7 pediatric specialists

35. Pediatric Trauma Center Criteria

36. How we do it.

37. Resources • Regional Trauma Advisory Council • http://www.dhs.wisconsin.gov/Trauma/councils/index.htm • Emergency Medical Services for Children • http://www.dhs.wisconsin.gov/emsc/ • http://www.chawisconsin.org • http://www.childrensnational.org/emsc/

39. summary • What is killing our children? • Pediatric assessment triangle • Know your resources • You can make a difference