Chapter 40 Pediatric Trauma Emergencies. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 2 Overview Pediatric

Chapter 40Pediatric Trauma Emergencies

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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved

Overview

Pediatric Trauma Assessments Blunt Trauma Burns Child Abuse Children with Special Needs

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Anatomic differences– Related to physical development– Head is larger in proportion to body, making

children top heavy– Higher ratio of body surface area to mass makes

children prone to hypothermia

Pediatric Trauma Assessment

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Mechanism of injury– Death from trauma is more frequent in children– Small children lack the understanding that injury

can occur– Adolescents knowingly participate in risky

behavior

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Initial assessment– Compare the actions of a sick child to those of a

normal child– A child’s smaller airway is more prone to

obstruction– Underdeveloped musculature in the chest may

increase breathing difficulty – Smaller blood volume than an adult can lead to life

threatening conditions


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Stop and Review

What are the typical causes of pediatric trauma?

What are the anatomic differences between a child and an adult?

What are the indications for transporting a child to a trauma center?

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Blunt Trauma

Need to compare size of child to MOI Can cause internal bleeding, hypoperfusion,

shock Signs of blunt trauma in children may be

subtle

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Blunt Trauma

Hypoperfusion– Compensate for blood loss well; however,

decompensation occurs quickly– Pale, diaphoretic, increased capillary refill, nausea– Compare radial and carotid pulses to determine if

shunting is occurring– Loss of consciousness and bradycardia are signs

of imminent cardiac arrest

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Blunt Trauma

Chest injury– A child’s ribs consist mainly of cartilage and are

very flexible– Ribs can bend inward and create underlying injury– Oxygenate, ventilate, and stabilize as necessary

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Blunt Trauma

Spinal injury– In deceleration injuries, the child is more prone

to spinal trauma because of the heaviness of his head

– Manual stabilization and oxygen administration are key to managing the child with spinal injury

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Blunt Trauma

Abdominal injury– The liver and spleen are only partially

protected by rib cage– These structures can be torn or ruptured

during blunt trauma to the abdomen

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Blunt Trauma

Head injury– Loss of consciousness, headache, blurred vision– Nausea and vomiting are more common in

children– Post-traumatic seizures may also occur– Manage oxygenation, ventilation, and circulation

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Blunt Trauma

Spinal immobilization– A car seat does not provide proper immobilization– Padding is necessary if the child is left in a car

seat– If removed from the car seat, a cervical collar or

padding may be used

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Blunt Trauma

Bony injury– Somewhat flexible, seldom break– There may be other injuries if a fracture

is observed– Immobilization and evaluation by a

physician is the proper course of treatment

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Burns

Maintain an open airway Estimate the percentage of body

surface area burned

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Child Abuse

Be alert to patterns of injury that do not match the MOI

Wounds in various stages of healing may indicate abuse

The child’s story and caregiver’s story don’t match

The caregiver takes the child to many different hospitals

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Courtesy of Emergency MedicalServices for Children, NERA,Torrance, CA

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Stop and Review

How would an EMT manage the pediatric patient with a:– Chest injury– Abdominal injury– Spinal cord injury– Long bone fracture– Injuries from suspected child abuse

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Children with Special Needs

Tracheostomies– A surgical opening in the front of the neck for

placement of a tube used as an artificial airway– Secretions may cause obstruction or difficulty

breathing– Oxygenation and ventilation should be provided

through the tube

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Mechanical ventilators– Machines to help with breathing– Do not attempt to manipulate the ventilator– Disconnect the ventilator and use a BVM for

ventilations– Call for an ALS intercept– If the child needs to be transported for reasons not

related to the ventilator, transport the ventilator with the child

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Central venous catheters– A tube placed within a large vein for repeated

access to the vein– Keep the site clean– Clamp the tube if bleeding is occurring at the

catheter site

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Feeding tubes– Soft, flexible tubes placed within the stomach

through the nose or the abdominal wall– Used to provide liquid nutrition– Rarely result in emergencies related to the

tube itself– Keep the tube clean and avoid pulling on it

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Cerebrospinal fluid shunts– A catheter used to drain excess fluid from the

brain and into the abdomen– Infection can cause problems with the shunt– Intracranial pressure may rise if the shunt is not

working properly

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Stop and Review

How should the EMT respond to children with special needs?

Documents

Chapter 40 Pediatric Trauma Emergencies. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 2 Overview Pediatric