Pediatric Emergencies in the Combat or Austere Environment: As Easy as A, B, C!

Abstract

The care of emergency problems involving the airway, breathing, or circulatory systems can be challenging in any patient population or setting. These can be particularly challenging when managing pediatric patients in an austere environment. The past decade-plus of combat operations in Iraq and Afghanistan have provided a generation of military surgeons with a large body of experience in care under some of the most challenging conditions, including providing care for a large volume of severely ill or injured pediatric patients. Although the general approach to these emergent problems, evaluation, and interventions should follow a similar approach to that outlined for adults, there are many subtleties that must be appreciated in pediatric patients that can greatly impact the efficacy, risk of complications, and ultimate outcomes. This chapter highlights the key issues, concerns, and practical advice for the provider who is faced with managing the emergency pediatric patient in this type of environment. This chapter is divided into three main sections, focusing sequentially on a case presentation followed by analysis and discussion, in the areas of managing an emergent airway (A) issue, an emergent breathing (B) issue, and an emergent circulatory problem (C). Practical advice and focused discussion of the optimal evaluation and management strategies, as well as an awareness of areas of potential pitfalls or major complications are highlighted. Successful management of emergency pediatric patients with A, B, or C issues can be readily achieved, even under these challenging and restrictive conditions, with a focused and team-based approach.