1. Paediatric Trauma Dr Marie Spiers
Paediatric Emergency Medicine Consultant
Paediatric Representative for STAG

2. Trauma Commonest cause of death in children> 1 year
22% all deaths 1-4 years
34% all deaths in older children (5-14 years)
4% deaths in infants
Important?
Significant number under 1= NAI

3. Causes of trauma deaths in children
RTA- 48%
Fires- 15%
Drowning- 12%
Hanging- 8%
Falls- 8%
NAI- 5%
Other- 4%

4. Geospatial distribution of trauma incidents attended by SAS Nov 2009-Oct 2010

5. Mortality Deaths following trauma fall into 3 groups:
Immediate- overwhelming injury incompatible with life.
Early- progressive respiratory failure, circulatory insufficiency, ICP.
Late- Rising ICP, infection, multi-organ failure.

6. Recognition Mechanism of injury Kinetics
Protection- seat belts, bike helmets etc
External injuries as clues to internal ones

7. Paediatric Specific Considerations
Weight:
Most rapid change in 1st year of life
(birth =3.5Kg, 5 months= 7kg, 1 year= 10Kg.)
Weight (Kg)= (Age (yrs)+ 4)x2
0-12 months= Wt (Kg)= (0.5x age in months) + 4
1-5 years= Wt (Kg)= (2x age in years) + 8
6-12 years= Wt (Kg)= (3x age in years) + 7
Broselow tapes
Proportions:
Head: 19% TBSA at birth, 9% by 15 years
Large head/ occiput and short necks.
<5yrs- spleen & liver palpable below costal margin

8. Paediatric Specific Considerations
More complaint bones
Epiphyses
Psychological- regressive behaviour
Hypothermia
Long term sequelae

9. Assessment

10. History A- Allergies M- Medications/ Immunisations
P- Past medical history
L- Last ate?
E- Events

11. Assessment Primary Survey Resuscitation Secondary Survey
Post Resuscitation care

12. Normal Physiology Breathing: Circulation:
Age RR/ min
<
>
Circulation:
Circulating volume 70-80ml/Kg
Heart Rate: Systolic BP
Age Bpm Age SBP
< <
> >

13. Primary Survey C-ABCDE
Catastrophic haemorrhage
Airway (with C-spine control)
Suction
Jaw thrust OP NP
Blocks/ in line stabilisation
NO COLLARS
Breathing
Effective, sustained and sustainable over time.
Supplemental O2
Supported ventilation

14. Primary survey- ATOM FC
Airway obstruction
Tension pneumothorax
Open pneumothorax
Massive haemothorax
Flail chest
Cardiac tamponade

18. Primary Survey Circulation (with haemorrhage control)
Direct/ indirect compression/Tourniquet
IV access x2 large bore (if possible)
IO- consider ‘above and below diaphragm’
Fluid- 10mls/Kg aliquots
Bloods products
20mls/Kg PRC; 5mls/Kg cryo; 20mls/Kg FFP
Tranexamic acid (15mg/Kg)
Abdo/ pelvis/ long bones
Stabilise pelvis, splint long bones

19. Response to Blood Loss <30% volume loss 30-45% volume loss
CVS
HR
Thready pulses peripherally
Normal SBP
Normal pulse pressure
/N BP
pulse pressure
Absent peripheral/ thready central pulses
BP
HR then HR
CNS
Anxious
Irritable
Confuses
Lethargic
 Response pain
Coma
Skin
Cool, mottled
CRT
Cyanosis
CRT
Pale
Cold
Urine output
Output
Minimal
None

20. Intraosseous EZIO or Cook needle Placement Proximal or distal tibia
Distal femur
Proximal humerus
Marrow can be sent for BM and crossmatch
All drugs, fluids and blood products can be given through IO- needs to be ‘pushed in’
Beware fractures proximal to IO site and epiphyses

25. Disability: Exposure: AVPU GCS Pupils DEFG- don’t ever forget glucose
Prevent  temp
Top to toe examination

26. Additional points Limb threatening injuries: Spine Urgent reduction
Splinting
ABx if open fractures
Spine
Move away from log roll- 20° tilt
Minimal handling
Scoop stretchers

27. Paediatric Trauma Imaging

28. Imaging Recommendations
Appropriate to the child's age and clinical condition
Reported by a suitably trained radiologist
Exposure to ionising radiation should be kept to a minimum
ALARA (as low as reasonably achievable) principles should be adhered to
Routine use of adult trauma protocols is inappropriate

29. Imaging Recommendations
TARN data shows the majority of paediatric injuries are to the extremities, head and to a lesser extent C-spine
Injury pattern in children is typically to an isolated anatomical area as opposed to multi site polytrauma
Should be mindful of this when considering the need for imaging in children with trauma

30. Questions ?