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Pitfalls in Paediatric Resuscitation
Brian Burns @HawkmoonHEMS
www.resus.me/swan24
AXIOMATIC
Kids are little adults
Severe TBI and haemorrhage
TOP
KILLERS
in
TRAUMA
Severe TBI
EARLY hypotension(PH/ED): SBP <5% centile = very bad
Hypoxia, hypercarbia = bad
Errors of OmissionCognitive overload
high performanceconsistencyfamiliarity
HaemorrhageDCR
Early products- ideal = whole blood
Haemostatic resuscitation
Minimising crystalloid
Avoid over-resuscitation
Avoid supernormal MAP
Rapid haemorrhage control
ATCShock Hypoperfusion
Coagulopathy?
Plasma-based lab tests
PT,aPTT, INR, fibrinogen, plt
poor clinical correlation
retrospective
Predefined MTP
TXA
< 3 hrs from injury
Who? : ATC/high risk ATC
15mg/Kg over 1 hr then 2mg/kg/hr over 8 hours
Transfusionsvolume overload
electrolyte disturbance
dilutional coagulopathy if not balanced
haemolysis
TRALI
MOF
PREDEFINED MTP=less MOF, infection, ventilation, mortality
SHOCK
Paediatric age-adjusted SI
Lactate >4
NARROW pulse pressure
InterventionsSAME indications as adults
Do it!
Resuscitative thoracotomy
Penetrating TCA <10min loss SOL or loss SOL in ED
Blunt TCA without SOL in ED unsalvageable
Logistics
Analgesia
Avoid oligoanalgesia
Subdissociative ketamine
Intranasal fentanyl
Kids are not little adults
• larger heads
• less fat
• more exposed solid organs
• pliable skeleton=
• force transmission
Injury Pattern
MVC/Pedestrian
Falls
Low penetrating
Physiology
hypovolaemia masked by reserve and compensation until >20% BV loss
high BMR= high O2 consumption
higher BSA to weight= hypothermia
Psychosocial
Behaviour regresses by 5 years
Parents in the resus room
Radiology
Focused CT. ALARA principle
eFAST ?
Non-operative critical care
Close observation v surgery
Trauma deaths
process
safeguard the future performance of team + system
Kids should sometimes be treated like little adults and sometimes they should not
Knowing when is the key