Paeds Trauma (Adult add-on)

Paediatric Trauma

Children differ anatomically and physiologically from adults! HOWEVER... The basic principles of trauma remain the same, regardless of age!

Injury is the leading cause of death in children

Evidence shows that trauma systems improve patient outcomes, yet trauma is the cause of morbodity and mortality in under 18s

A holistic family centred approach to care improves co-operation, experience and overall wellbeing

There is evidence that up to 50% of children with significant trauma still present to trauma units/local EDs, rather than MTCs

Historically, blunt trauma has been the most common mechanism of injury in paediatric trauma

Injury occurs at all ages in children and young adults with a bimodal distribution in under 2s and adolescents

However, there has been a significant rise in penetrating trauma in the adolescent group with victims of assault presenting younger with more injuries

Key Considerations

The Brain

The Head

Large Head - surface area is larger. Newborns = 20% 15yrs = 10%

Age related difficulty with neurological/pain assessment - paediatric AVPU/GCS

Large occiput in young children - neutral position needed for intubation

Methods of analgesia may be difficult - IV access/refusing orals

C-Spine

Body Surface Area

C2/3 fulcrum (pivot) of C5-6 adults Spinal injuries less common as increased mobility and cartiliagious vertebrae

Weight ratio is higher than adults - heat/fluid losses (burns) are increased - increased risk of hypothermia

Key Considerations

Cardiovascular

Breathing

Increased respiratory rate (higher O2) Increased oxygen consumption, therefore desaturate quicker Flexible, compliant ribs means less intrathoracic protection Quicker diaphragmatic fatigue Risk of gastric distention and ventilator compromise with assisted ventilation

Usually, healthy children can compensate well until advanced shock. They can lose 30-40% of circulatory volume before hypotension ensues

Airway

Large tongue Wobbly/loose teeth Larger, floppy epiglottis

Narrowest point is the cricoid ring Shorter trachea means increased risk of endobronchial intubation

Narrower airways - odema causes rapid narrowing

Key Considerations

Circulating Volume

Abdomen/Pelvis

80mls/kg compared to 70mls/kg in adults Children have a smaller body size, therefore less circulating volume

Ribs more compliant therefore less protection of upper intra abdominal oragns, especially the liver and spleen

Newborn - 3kg = 255mls Infant, 2yrs - 12kg = 525mls Child, 5 yrs - 18kg = 1260mls Adult - 65kg = 4225mls

Bladder is not protected by the pelvis

WE TFLAG

WEight = Age + 4 / 2

ENERGY = 4J X WEIGHT

tube = age/4 + 4

fluids = 10mls x weight

lorazepam = 0.1mg/kg

adrenaline = 0.1mg/kg

1:10,000 Adrenaline

glucose = 2mls/kg

10% Glucose

SAFEGUARDING - NAI

Is the responsibility of all!

Non-Accidental Injuries are not always apparent at the first instance

SOME Red Flags...

• Bruising in children <1yrs
• Bruising to face/buttocks, back or hands
• Bruising in shape of an object/ligature
• Posterior rib fractures
• Multiple rib fractures
• Delay in seeking treatment
• Inconsistencies in history provided
• History that isn't consistent with developement

Always document and escalate - even if you're not sure

PLEASE FEEL FREE TO DROP US AN EMAIL FOR MORE PAEDIATRIC LEARNING OPPORTUNITIES AVAILABLE ...

Chantelle.wilkinson@nhs.netemma.broomfield@nhs.net