Victorian State Trauma System Guideline
Paediatric Trauma
Make early contact with PIPER for
advice from the Paediatric Major
Trauma Service & to initiate retrieval.
• Gather vital information
• Designate roles
AIRWAY / C-SPINE
• Protect Airway
• Adjuncts as necessary
• Maintain full spinal
precautions with neutral
alignment
Only an experienced clinician should attempt intubation in a young child. Prior to attempting intubation, always have a plan for managing a difficult airway or failed intubation.
N Inter-hospital major trauma
• Perform secondary survey.
• Monitor closely.
• Observe in facility for at
least 2 hours.
• Provide required care,
discharge and follow up
as necessary.
• Perform complete trauma evaluation
including seconary survey.
• Monitor vital signs closely.
• Observe in facility.
• Seek advice from Paediatric Trauma
consultants via PIPER regarding treatment
options.
• Provide required care.
• Contact PIPER if any deterioration in
patient’s condition occurs.
PIPER
Paediatric Infant Perinatal Emergency Retrieval
  
• Never leave a patient without an established care plan
• Delayed management of the obstructed airway and inadequate fluid resuscitation
and strategy for review
are two of the most preventable causes of death in paediatric patients.
• Always feel comfortable to escalate or ask for help
• The family of an injured child requires appropriate support and explanation.
H o l l o w a y P r o d u c t i o n s | T r a u m a Vic | Final
Early Activation
• Ensure safety using PPE • Activate Trauma Team • Perform calculations based on estimated weight or Broselow tape guide
• Set up to receive patient • Call for help early • Predetermine age / weight specific interventions
Primary Survey
BREATHING CIRCULATION DISABILITY EXPOSURE / ADJUNCTS
• Identify & treat any life threats • Insert peripheral IV cannula x 2 • Assess level of
ENVIRONMENT
• X rays: Chest, Pelvis
• Measure RR & work of • If difficult, insert Intraosseous consciousness • Fully expose patient • Analgesia
breathing using AVPU
• Take blood • Prevent heat loss • Consider eFAST scan
• Oxygen therapy to maintain • Check pupils
• Assess HR / BP / skin perfusion • Log roll in adolescents > 50kg
SpO2 94 - 98% • Check BSL
• Assess central capillary refill time
• Listen for expiratory “grunting”
Paediatric Vital Signs Major Trauma Criteria
Age Term - 3 mths 4-11 mths 1-4 yrs 5-11 yrs 12-15 yrs
Does patient meet the HR <100 or >180 <100 or >180 <90 or >160 <80 or >140 <60 or >130
Y RR >60 >50 >40 >30 >30
transfer criteria?
BP sys <50 <60 <70 <80 <90
Sp02 <90%
Notify PIPER to conduct GCS <15
case assessment
Calculations
Weight Burn Resuscitation fluid:
0.9% NaCl / Hartmanns.
• Age 0-1: weight = (age / 2) + 4
N • Age 1-5: weight = (age x 2) + 8 • For burns with >10% TBSA
Patient meets potential
major trauma criteria? • Age 6-12: weight = (age x 3) + 7 • Modified Parklands formula of 3ml x
Endotracheal tube TBSA% x kg= _ml/24 hrs.
Y • The endotracheal tube size (age / 4) + 4 • 50% is given in the first 8/24 post injury,
and 50% given in the following 16/24.
(use 1/2 size down if using microcuff ETT
where available). Maintenance fluid
• The depth of endotracheal tube insertion: • Normal daily fluid requirements in children up
• Prepare patient for retrieval & definitive care. to 30kgs:
• Perform any interventions as necessary • neonates: 10cm.
• Up to 10kgs: 100ml/kg/day.
to stabilise patient prior to transfer. • infants <1yr: 11cm. • 10-20kgs: 1000mls plus 50ml/kg/day for
• Conduct a neuroliogical exam using an age each kg over 10kgs.
appropriate assessment scale . • children over 1yr: length (cm) = (age/2)
• 20-30kgs:1500mls plus 20ml/kg/day for
• Assess pain using an age appropriate scale + 12.
each kg over 20kgs.
and administer analgesia as required. • Intubation must be verified with ETCO2
• Continuously monitor & frequently reassess • Potassium chloride supplements may
ABCD. Fluid resuscitaton be required.
• Ensure child’s family is involved in each • 20 ml / kg of 0.9% NaCl
step of the patients care.
• Communicate any new clinical developments Paediatric Sub-guidelines
or significant deterioration to PIPER.
• Ensure clear, accurate and concise Traumatic Brain Injury Spinal Trauma
documentation .
• Take a history using AMPLE. • Use the modified GCS to assess • Significant spinal injury may occur without
neurological state in children. fracture.
• Seizures are common in children after head Burns
injury: maintain inline c-spine immobilisation • Use the Lund & Browder method for
and nurse in reverse Trendelenburg assessing Total Body Surface Area (TBSA)
position. in children accurately.
1300 13 76 50
28/07/2017 | Version 2.0 | Contact us: Trauma.Victoria@ambulance.vic.gov.au
Statewide
24 hours