TRANSITION SERIESTRANSITION SERIES

Topics for the Advanced EMTTopics for the Advanced EMT

CHAPTERCHAPTER

Trauma in Special Trauma in Special Populations: PediatricsPopulations: Pediatrics

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ObjectivesObjectives

• 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.

IntroductionIntroduction

• 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.

EpidemiologyEpidemiology

• 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.

Trauma Scoring SystemsTrauma 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

Pediatric Glasgow Coma Scale

Pediatric Glasgow Coma Scale

Pediatric Glasgow Coma Scale

Assessment and CareAssessment 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

Assessment and Care (cont’d)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.

Assessment and Care (cont’d)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.

Assessment and Care (cont’d)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.

Assessment and Care (cont’d)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

Assessment and Care (cont’d)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.

Assessment and Care (cont’d)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.

Assessment and Care (cont’d)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%).

Assessment and Care (cont’d)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.

Assessment and Care (cont’d)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.

SummarySummary

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

Summary (cont’d)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.