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EMTPediatricTrauma - Pediatric Trauma Pediatric Temple...

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Unformatted text preview: Pediatric Trauma Pediatric Temple College EMS Professions Pediatric Trauma Pediatric s s s #1 killer after neonatal period Priorities same as in adults ABC’s Children are not just little adults! Airway Airway s Anatomy increases upper airway Anatomy obstruction risk obstruction – – – – s Large head Short neck Small mandible Large, posteriorly placed tongue Children do NOT mouth breathe well Children NOT Airway Airway s s s Neck over-extension may obstruct Neck airway due to high glottis airway Use sniffing position if neck injury Use not suspected not Chin lift important to get tongue out Chin of airway of Breathing Breathing s s s s Small passages obstruct easily Horizontal ribs, weak accessory Horizontal muscles = Poor respiratory reserve muscles Swallowed air may limit ventilations Anticipate need to assist ventilation Breathing Breathing s s s Fast breathing may be normal Breathing at normal adult rates (1020/min) may indicate respiratory failure Auscultation of chest may be misleading Auscultation (transmitted breath sounds) (transmitted Breathing Breathing s s High metabolic rates + Low reserve High capacity = High sensitivity to airway, breathing problems breathing Oxygenate, ventilate aggressively Circulation Circulation s s s Rapid control of external bleeding Rapid essential due to small blood volume essential Efficient compensation makes Efficient recognition of shock difficult recognition Sudden decompensation, onset of irreversible shock may occur irreversible Circulation Circulation s s BP monitoring = Poor shock indicator Assess perfusion using: – Peripheral pulse rate, quality – Skin color, temperature – LOC (Silence is not Golden) – Capillary refill Management Management s s s s Airway 100 % O2 Consider early ventilation Prevent hypothermia – Large surface/volume ratio = Large increased heat loss increased – Cover with blanket Head Trauma Head s Major cause of death – Large heads – Thin skulls – Poor muscle control s Diffuse edema more common than Diffuse intracranial hematomas intracranial Head Trauma Head s Monitor for signs of increased ICP – – – – s s AVPU Pupils Vomiting Cushing’s triad Hyperventilate Resuscitate hypovolemic shock aggressively Spinal Trauma Spinal s Uncommon – Usually occur at C1, C2, C3 (high C-spine) – Dislocations more common than fractures s Suspect if trauma involves: – Sudden deceleration – Head injuries – Decreased LOC s Resist temptation to pick child up and run! Chest Trauma Chest s s s Second only to head trauma as cause Second of trauma deaths of 90% blunt Chest wall flexible: Chest – Rib fracture uncommon – Extensive intrathoracic injury can Extensive occur without rib fracture occur Chest Trauma Chest s Mobile mediastinum – Poor tension pneumothorax tolerance s Limited respiratory reserve – Poor chest injury tolerance Abdominal Trauma Abdominal s s s Most common pediatric trauma form Most Usually blunt Liver, spleen injury more common Liver, than in adults than – High, broad costal arch – Relatively larger organs – Weak abdominal wall Abdominal Trauma Abdominal s s Tenderness = Significant trauma Tenderness until proven otherwise until Distension = Significant trauma until Distension proven otherwise proven Extremity Trauma Extremity s s s Never severe enough to warrant attention Never before head, chest, abdominal injury before Priorities remain with ABC’s Pliant bones absorb/ dissipate significant force – Greenstick fractures common – Treat painful, tender, guarded extremities as Treat fractures fractures Burns Burns s Children account for: – 50% of burn admissions – 33% burn deaths s Large body surface area increases: – Fluid loss – Heat loss (hypothermia risk) s Smaller airway – Increased obstruction risk Burns Burns s Consider possibility of child abuse: – Story does not match pattern of burn – “Stocking” or “glove” injury – Unusually deep burns ...
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