Pediatric Trauma Resuscitation

Abstract

Evaluation and treatment of the pediatric trauma patient has some key differences from the adult patient. Blunt trauma is the most common mechanism of injury, but because of abdominal wall compliance, can produce injuries that resemble penetrating mechanisms (i.e., handlebar injury producing small bowel perforation). Cardiac arrest is most often respiratory in etiology, and a Miller blade and cuffless endotracheal tube (the size of a child’s pinky finger) are used for rapid sequence intubation. Nasogastric tube decompression can relieve respiratory distress from gastric distension in a crying child who has swallowed air. Children have impressive physiologic reserve and can maintain SBP until severe blood loss (>30%), so do not be reassured by normal blood pressure. Intraosseous line is an excellent source of vascular access when peripheral IVs cannot be established. If hypotensive, a bolus of crystalloid (20 mL/kg) may be administered twice while assessing response. Subsequent volume resuscitation should be with blood products (10 mL/kg). Many solid organ injuries in children can safely be managed nonoperatively. A high index of suspicion for non-accidental trauma must be maintained by any practitioner caring for pediatric trauma patients.