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Pediatric Trauma Update: Key Differences in Adult vs Child Assessment

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Dang Thanh Tuan
Dang Thanh Tuan
Gesundheit & Medizin
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Pediatric Trauma Update Robert W. Letton, Jr., MD Associate Professor of Pediatric Surgery Oklahoma University Health Sciences Center
GOAL ,[object Object],[object Object],[object Object]
PRIMARY SURVEY
Primary Survey ,[object Object],[object Object],[object Object],[object Object],[object Object]
Airway ,[object Object],[object Object],[object Object],[object Object]
Airway ,[object Object],[object Object],[object Object],[object Object]
Airway ,[object Object],[object Object],[object Object],[object Object]
Airway ,[object Object],[object Object],[object Object],[object Object],[object Object]
The Great Debate ,[object Object],[object Object],[object Object],[object Object],[object Object]
Rapid Sequence Intubation Avoid Propofol and Ketamine in head injury patients Watch hypotension with sedatives and barbiturates
ETT Size ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Airway ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Larynx Trauma
Breathing ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pulmonary Contusion ,[object Object],[object Object],[object Object],[object Object]
Pulmonary Contusion Rx ,[object Object],[object Object],[object Object],[object Object],[object Object]
Tension Pneumothorax ,[object Object],[object Object],[object Object],[object Object]
Pneumothorax
Breathing ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Open Pneumothorax
With penetrating rib injury
To hilum and RLL
Breathing ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Worrisome CXR???
Torn Aorta
Torn aorta
Aortic Tear
Circulation ,[object Object],[object Object],[object Object],[object Object]
Circulation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Circulation ,[object Object],[object Object],[object Object],[object Object]
Circulation ,[object Object],[object Object],[object Object],[object Object]
Circulation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Pediatric Vital Signs
Clinical Signs of Shock
Circulation ,[object Object],[object Object],[object Object],[object Object],[object Object]
Intraosseous Line ,[object Object],[object Object],[object Object],[object Object],[object Object]
Fluid Resuscitation
Hypovolemic Shock ,[object Object],[object Object],[object Object],[object Object]
Hypovolemic Shock ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hypovolemic Shock Child in extremis with normal CXR, pelvis film and no long bone fractures or lacerations needs a trip to the OR to complete their Primary Survey!
Disability ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Glasgow Coma Score Decorticate (flexion) posturing Decorticate (flexion) posturing 3 No response No Response 1 Decerebrate (extensor) posturing Decerebrate (extensor) posturing 2 Withdrawal to pain Withdraws to pain 4 Localizes pain Withdraws to touch 5 Follows commands Spontaneous 6 Motor Response No response No response 1 Incomprehensible Grunts or moans 2 Inappropriate Persistently irritable, crying 3 Confused Cries but consolable 4 Appropriate, oriented Smiles, coos, cries appropriately 5 Verbal Response No response No response 1 To pain To pain 2 To verbal stimuli To loud noise 3 Spontaneous Spontaneous 4 Eye opening CHILD INFANT SCORE CRITERIA
Disability ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prevent Secondary Injury ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prevent Secondary Injury ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Maintain Adequate Cerebral Perfusion Pressure ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SECONDARY SURVEY
Abdominal Trauma ,[object Object],[object Object],[object Object],[object Object],[object Object]
Abdominal Trauma Lab Data/Radiology ,[object Object],[object Object],[object Object],[object Object],[object Object]
Abdominal Trauma Imaging Studies ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Abdominal Trauma CT Scan ,[object Object],[object Object],[object Object],[object Object],[object Object]
Abdominal Trauma CT of the abdomen & pelvis is not effective for ruling out hollow viscus injuries
Abdominal Trauma Diagnostic Peritoneal Lavage ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Abdominal Injuries ,[object Object],[object Object],[object Object],[object Object]
Solid Organ Injury ,[object Object],[object Object],[object Object]
Solid Organ Injury ,[object Object],[object Object],[object Object],[object Object]
Pediatric Spleen Injury: Retrospective Review Stylianos, et.al., JPS 35:164-9, 2000
Pediatric Spleen Injury: Prospective Trial Stylianos, et.al., JPS 35:164-9, 2000
Pediatric Spleen Injury ,[object Object],[object Object],[object Object],Stylianos, S. J Ped Surgery 2002 Mar:37(3):453-6
Seat Belt Stripe ,[object Object],[object Object],[object Object],[object Object],[object Object]
Seat Belt Stripe ,[object Object],[object Object],[object Object]
CT Scan and Bowel Injury ,[object Object],[object Object],[object Object],Admission 24 HR later Duodenum
Seat Belt Stripe ,[object Object],[object Object],[object Object]
Post-Trauma Bowel Obstruction ,[object Object],[object Object],[object Object]
Bicycle Handlebar Injury ,[object Object],[object Object],[object Object]
Pancreas Injury ,[object Object],[object Object],[object Object]
Abdominal Trauma Genitourinary System ,[object Object],[object Object],[object Object],[object Object],[object Object]
Abdominal Trauma Genitourinary System ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Child Abuse “RED” Flags ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Child Abuse: Physical Exam ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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