PEDIATRIC TRAUMA • Good compliance of blood pressure → tekanan darah cukup stabil

→ makanya jika sudah hipotensi maka kehilangan darah sudah

• 12.000 cases/year in US 40%
• High mortality rate • Initial sign of hypovolemia ➔ tachycardia
• Emergency Room: leading cause • Blood pressure still normal until 40% of blood lose
• 90% cases → blunt trauma (KLL, fisik dll) • Difficulty in iv line insertion (venous cutdown, intraosseous)
• Mostly multple trauma (kepala + thorax + abdomen dll) • 20 cc/kg BW crystalloid → hanya 1 x → dan should be followed
• Unique anatomy, physiology by blood transfusion (if still unstable)
• Managemet: primary survey ( A -> B -> C -> D-> E) → secondary survey • Endpoint of resuscitation:
1) Normal HR
PRIMARY SURVEY 2) Increasing pulse pressure
A. AIRWAY 3) Improved skin colored and warmth
4) Clearing sensorium (GCS)
5) Increasing MAP
6) Normal production of urine (1 cc/kg BW/hour)

D. DISABILITY
• GCS pediatric
• Bigger head (1:3 bayi baru lahir) of infants → prone to trauma
• Open occiput → rentan infeksi SSP
• SCIWORA (spinal cord injury without radiographic abnormality)
→ tidak ada tanda2 fraktur vertebrae tapia da defisit neurologis
→ bungkus utuh tapi isi rusak (karena tulang lebih lunak lebih
sulit tercedara/patah)
• Interspinous ligaments and joint capsules are more flexible

E. EXPOSURE
• Risk of hypothermia → bayi tidak dpt menggigil u/ menghasilkan
panas
• Covering body with warm suit
• Removing wet suit
• Hypothermia leads acidosis, coagulopathy, arrythmyas

SECONDARY SURVEY
1. Check all the body part
• oksiput anak >tebal/menonjol → saat berbaring tanpa alas maka 2. Head to toe
leher akan tertekuk → sehingga perlu diganjal dibahu-tungkai 3. Front and back
agar tubuh lebih maju dari oksiput 4. Injury mechanism
• lidah bayi > cavum orisnya 5. Pain management
• bekuan darah → cukup dapat menyebabkan obstruksi airway pd Special Conciderations:
bayi

B. BREATHING
• Infants: obligate nose-breather → tidak ada refleks bernapas
dengan mulut jika hidung ditutup.
• Bradipneu/Apneu → common cause cardiac arrest
• Gastric distension → respiratory problem ➔ saat bagging ada
kemungkinan O2 masuk ke gastric → pernapasan normal bayi
(abdominal) terganggu
• Normal range depends on age • Head: relatively bigger
o neonates (sd 28 hari): 30-60x/menit • Neck: short, SCIWORA
o infant (2 bln-1 tahun): 30-40x/menit • Thoracic: Thinner intercostal muscle
o 2-5 thn: 20-30x/menit • Abdominal: Unprotected liver and spleen (lebih ke bawah & tidak
o 5-12 thn: 15-20x/menit terlindungi dg costae), intra abdominal bladder (lebih ke atas dari
o >12 thn: 12-15x/menit pubis)
• Thinner chest wall • Musculosceletal: open epiphyseal plate → kalau cedera →
• Costae lebih lentur → perlu energi >>> dapat rusak → Broken gangguan pertumbuhan tulang
costae → pertanda big trauma
• Risk of pulmonary contusion
ADJUNCT EXAMINATIONS
C. CIRCULATION • USG
• Total body volume small • CT Scan
• 80 cc/kgBW → ex: bayi 3 kg voldar total 240 cc ➔ perdarahan • Lab
10 cc sangat bermakna • X-ray → jika benar2 diperlukan → ada risiko keganasan darah
• Never ignore even small volume of blood
 PEDIATRIC TRAUMA SCORE (PTS)
→ melihat prognosis pasien pediatrik yang mengalami trauma

CHILD ABUSE/MALTREATMENT

Hal-hal yang dapat ditemukan:

➢ Late assessment → datang saat kondisi telah parah missal syok
➢ Repetitive trauma → ada trauma baru di tempat lain dan trauma lama
➢ Inappropriate/discrepancy history – findings
➢ History different between parents or caregiver
➢ Findings: multicolored bruises (ada luka baru dan lama), frequent
previous injury (old scar), trauma daerah yang tidak biasa (perioral
injury, genital and perianal injury), fracture of long bone (ini sulit
terjadi kecuali energi besar) in younger than 3 year of age, ruptureed
internal viscera without antecedent major blunt trauma, multiple SDH
(SDH jarang berbagai tempat)