Trauma in Children

Objectives

• To understand the structured approach to the

injured child

• To recognise the physiological, anatomical and

psychological differences between children
and adults

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 Trauma in Children
Children vs Adults
• Anatomical differences (especially airway)

• Physiological differences

• Psychological differences

Trauma management principles are the same

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 Trauma in Children
Anatomical differences

• Large surface area to volume ratio

• Minimise exposure to prevent hypothermia

• Weight = (age + 4) x 2

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 Trauma in Children
Airway differences
• Head + tongue larger

• Larynx higher + epiglottis bigger

• Cricoid is narrowest part of airway

• Particularly in children < 4 years

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 Airway difference
• Uncuffed endotracheal tubes preferred

• ETT size = Age/4 + 4

• Child’s little finger or nostril

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 Trauma in Children
Breathing differences

• Air swallowing common in distressed children

• Gastric distension compromises lung function

• Gastric decompression useful

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 Trauma in Children
Circulation Differences
• Normal values vary with age

• Wide range of normal BP + heart rate

• Capillary refill time very useful sign

• Pulse palpation - Femoral artery , Brachial artery

• IV Cannulation - Long saphenous vein (ankle),

Femoral vein
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 Trauma in Children
Circulation differences - Shock
• Tachycardia
• Weak pulse
• Capillary refill > 2 seconds
• Tachypnoea
• Agitation
• Drowsiness
• ↓ Urine output
• Hypotension may be a late sign in children

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 Intraosseous Access
• Relatively safe + effective

• Anteromedial aspect of tibia below tibial tuberosity

• Other long bones

• Avoid epiphyseal growth plate

• Intraosseous needle or spinal needle

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 Trauma in Children
Fluid Resuscitation
• Initial bolus 20ml/kg

• Second bolus 20ml/kg

• If no response give blood

• Aim for urine output 1-2 ml/kg/hour in infant

• Warm fluids if possible

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 Trauma in Children
Psychological Differences
• Distress may not be due to pain

• Unhappy child is difficult to assess

• Consider parental presence at all times

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 Trauma in Pregnancy
Objectives

• To understand the structured approach to the

injured pregnant woman

• To recognise the physiological and anatomical

changes in pregnancy that influence
management

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 Trauma in Pregnancy
Anatomy - Fundal height
12 weeks symphysis pubis

20 weeks umbilicus

36 weeks xiphoid

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 Trauma in Pregnancy Physiological changes
• Tidal volume ↑

• Cardiac output ↑ 30%

• Blood volume ↑ 40%

• BP ↓ 15mmHg in second trimester

• HR ↑ 10-15

• Prone to aortocaval compression

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 Trauma in Pregnancy
Other Issues
• Uterine irritability and premature labour

• Rupture of uterus (partial or complete)

• Placental separation

• Pelvic fractures may result in severe blood loss

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 Trauma in Pregnancy Management
• ABCDE of mother

• Left lateral tilt

• Vaginal examination

• Mark fundal height

• Look for fundal tenderness

• Monitor fetal heart rate

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 Trauma in Pregnancy
Summary
• Important anatomical and physiological

considerations

• Resuscitation of the mother is also resuscitation of the

foetus

• Mother comes first

• Trauma management principles are the same

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BE CAREFUL OUT
THERE
WHATEVER
YOUR MODE OF
TRANSPORT!!! :O)