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Pediatric Trauma Case Studies: Assessment and Intervention

Pediatric Trauma Case Studies: Assessment and Intervention. Ankush Gosain, MD, PhD, FACS Medical Director, Pediatric Trauma Program American Family Children’s Hospital University of Wisconsin – Madison 06 December 2012. Disclosures.

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Pediatric Trauma Case Studies: Assessment and Intervention

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  1. Pediatric Trauma Case Studies:Assessment and Intervention Ankush Gosain, MD, PhD, FACS Medical Director, Pediatric Trauma Program American Family Children’s Hospital University of Wisconsin – Madison 06 December 2012

  2. Disclosures • I do not have any relationships with commercial interests to disclose. • I do not intend to reference unlabeled or unapproved uses of drugs or products in my presentation.

  3. Objectives • 1. To understand the incidence and epidemiology of pediatric trauma. • 2. To understand pediatric anatomic and physiologic factors relevant to pediatric trauma resuscitation. • 3. To understand the current approach to management of pediatric solid organ injury

  4. Objectives • 1. To understand the incidence and epidemiology of pediatric trauma. • 2. To understand pediatric anatomic and physiologic factors relevant to pediatric trauma resuscitation. • 3. To understand the current approach to management of pediatric solid organ injury

  5. Objectives • 1. To understand the incidence and epidemiology of pediatric trauma. • 2. To understand pediatric anatomic and physiologic factors relevant to pediatric trauma resuscitation. • 3. To understand the current approach to management of pediatric solid organ injury

  6. Children are NOT just small adults • Anatomic considerations • Physiology responds differently to trauma • Injury patterns differ from adults

  7. Anatomy - Airway • Larger head • Smaller jaw • Short, narrow airway

  8. Anatomy – Head/Spine

  9. Anatomy - Head • Soft cranium • Open fontanelle – easy estimate of fluid status/intracranial pressure

  10. Anatomy - Spine • Spine • SCIWORA • Flexible ligaments • Pseudo-subluxation

  11. Anatomy - Chest • Soft flexible chest wall • Weak muscles • Significant force required to fracture ribs

  12. Anatomy - Abdomen • Liver and spleen project farther below the costal margin • Thin abdominal wall • Multiple injuries common

  13. Physiology – Vital Signs • Different normal range

  14. Physiology • Blood volume • About 70-80 mL/Kg • Resuscitation/Blood Loss need to be Weight-based

  15. Physiology • Vigorous ability to compensate for blood loss – typically increased HR • May see very little change in vital signs until loss of 30% of intravascular volume

  16. Physiology • Sudden cardiovascular collapse

  17. Physiology – Blood Loss

  18. Physiology - Thermoregulation • Higher body surface area to mass ratio • Thin skin • Limited subcutaneous fat

  19. Physiology – Hypothermia • Keep them dry • Keep them covered • Keep the heat on • Warmed fluids and blankets if available

  20. Differences Between Adults and Children

  21. Differences Between Adults and Children

  22. Injury Prevention • Helmets • Window locks • Seat belts/car seats • Motorized vehicles

  23. Abuse/ Non-accidental trauma • About 7% of admissions to a pediatric trauma center • More severe injuries • Younger • Higher mortality (9%)

  24. NAT – History • Delay in care • Repetitive injuries • Discrepancies • Inappropriate responses • Medical neglect

  25. NAT – Physical Exam • Multicolored bruises • Femur fractures • Unusual scald/contact burns • Bilateral subdural hematoma • Retinal hemorrhage

  26. Response to abuse • Document the “story” • Don’t ask too many questions • Treat the trauma • Report, report

  27. Objectives • 1. To understand the incidence and epidemiology of pediatric trauma. • 2. To understand pediatric anatomic and physiologic factors relevant to pediatric trauma resuscitation. • 3. To understand the current approach to management of pediatric solid organ injury

  28. Non-operative management of splenic trauma • Prior to the 1960s – routine splenectomy for injury • “not a vital organ” • Risk of OPSS recognized • Non-operative management championed in pediatric patients • Success led to adoption of practice by adult trauma surgeons in the late 1990s

  29. Spleen Injury: Non-operative Management • Hospital for Sick Children, Toronto • First proposed non-operative management in 1948 • Upadhyaya & Simpson. SurgGynecol Obstet. 1968. • Douglas & Simpson. J Peds Surg. 1971.

  30. AAST Spleen Injury Scale

  31. Non-operative Management Rate Splenic Salvage LOS Mortality Transfusion Rate

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