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PEDIATRIC TRAUMA

Bagian Bedah FK-UA / RSUP DR. M. Djamil


Padang
Epidemiology Of childhood Injury
Trauma is a most caused of death
- Trauma 49 %, and Congenital A. 30 %
- 15.000 and 25.000 deaths anually ( U.S)

Motor Vehicle is the most common Cause of injury

Most common of injury mechanism is Blunt trauma


Special Consideration
1. Size And Shape

2. Skleton

3. Surface Area

4. Pshychologic status

5. Long-term Effect

6. Equipments
Airway Anatomi

1. Craniofacial Disproportion

2. Large Occiput  Cervical flexion

3. Infant Obligate Nasal Breathers

4. Larynx anterior caudad angle

5. Trachea short
Airway Management

• Head : Sniffing Position

• Suction  Oxygenate  Ventilated

• Endotracheal Intubation

• Needle crico thyroidotomy


Breathing and Ventilation

• Rate

• Tidal Volume

• Caution !!!!  Hypoventilation

• Tube Thoracostomy
Hemodynamic changes

Setiap terjadinya perubahan status hemodinamik akibat

perdarahan akan mempengaruhi kec. Nadi, tekanan

Darah, dan cardiav output


Shock and Management

• Fluid Resuscitation

– Blood Volume = 80 ml/KgBB

– Bolus 20 ml / Kg warmed Ringer Lactate

– Setelah 3 X pemberian cairan pikirkan penambahan PRC

– Temperatur Regulation
Shock and Management

• Responses to Treatment

– Usual : Crystalloid  Bolus  Normal No Operation

– Common : Crystalloid + PRBCs  Normal no Operation

– Rare : Crystalloid + PRBCs  No respons  Operation


Chest Trauma

• Rib Fractures  Severe Injuring Force

• Compliant chest wall  Lung Contusion

• Mediastinal mobility  Sensitivity to Pulmonal Injuries

• Thoracotomy  usually no Needed


Abdominal Trauma

• Method of Assesment

• Gastric distention

• Urinary catheter

• Diagnostic Adjuncts  CT with Contrast & DPL


• Management : Operative Or Non operatively  Surgeon
Head Trauma

• Differences with Adult


- Anatomic : Fontanelles, Suture line
- Outcame
- Extracranial Injuries
- Hypotension

• Management same as Adult


Pediatric Verbal Score

• Appropriate Words 5

• Cries bau consolable 4

• Persistently Irritable 3

• Restless, Agitated 2

• None 1
Musculoskletal trauma

• Management

• History important

• Growth plate freq. involved

• Blood loss prop. Greater

• Unique Fractures
Child Abused

• Discrepancy exists between the History and the degree


of physical injury

• A prolonged interval has passed between the time injury


and the seeking of med. Advice

• Repeated trauma

• Parent respond inappropriately


• The history of injury differs between parents or Guard.
TERIMA = KASIH