Pediatric Trauma2014 Emergency Care Trauma Symposium
June 24, 2014
Michael Kim, MD
objectives
• Epidemiology• Resources• Pediatric Assessment Triangle• Trauma approach • Destination: how and where?
Pediatric Trauma• Leading cause of death: 1-15 yr• 22 million injured / yr• 9.2 million ED visits• 20K deaths / yr• 50K permanent disabilities
• Economic impact: $10,000,000,000 per year
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Injury PreventionYou can make a difference !
Resources for optimal prehospital care
• Training • Equipment• Support and resources
EMS pediatric education / exposure
• BLS training in pediatrics: 8 hrs• ALS training in pediatrics: 16 hrs• Percentage of pediatric runs: 10%• % of all peds runs requiring ALS: 12 %• BMV: 1 in every 1.7 years• ETT: 1 in 3.3 years• IO placement: 1 in 6.7 years
Pediatric and trauma training
Pediatric and trauma training
Anatomy
• Not just smaller• Bigger head• Airway• Musculoskeletal• Organ proportions• Greater surface to volume
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The percent of patient care units in the State/Territory that have the essential pediatric equipment and supplies as outlined in national guidelines.
EMSC Performance Measure 73
2010 EMSC Program
The percent of patient care units in the State/Territory that have the essential pediatric equipment and supplies as outlined in national guidelines.
Wisconsin BLS PCUs: 57/203= 28% (National Average 23%)ALS PCUs: 81/353 = 23% (National Average 34%)
EMSC Performance Measure 73
2010 EMSC Program
WI EMSC Pediatric Jump Kit
Resources
• 9 y/o missing for 30 min • found face down next to rolled over ATV• no protective equipment• active hemorrhage from scalp• PNB at the scene
Approach to trauma patient
• Airway• Breathing• Circulation• Disability• Exposure/Environment
Initial Assessment
Airway• Normal speech & crying• Talking?• Crying?• Airway noises• Stridor
Appearance• AVPU• A &O• Confused• Irritable• GCS
Respiratory effort• Retraction• Rate• Nasal flaring • Grunting• Gasping• Abdominal breathing• Wheeze• Pulse oximetry• Endtidal CO2Circulation
• Heart rate• Hypotension• Mental status• Cyanosis• Pale• Cool to touch• Weak pulse• Poor capillary refill
Disability
Pediatric GCS
Intervention?
• No resp effort• No pulse• Cyanotic
• No movement
Interventions
Respiratory effort• Supplemental oxygen• PEEP• + pressure ventilation
Circulation• Stop hemorrhage• Temperature• Fluid resuscitation
Airway• Open airway• Jaw thrust (c-spine)• Oral airway• Maintainable?
Appearance• Stimulate • Interact• Support/console
Airway and Breathing
Circulation
• assessment • intervention
Next
• Disability (Dexi)– Glasgow Coma Scale
(age appropriate)– Brief neurologic eval– Splint and immobilize
• Exposure– Head to toe look see– Temperature control
Development and emotional
• Age dependent abilities and understanding– Stranger anxiety– Crying– Attitude– Reaction to…
• Intervention– Parental presence– No surprises– Distractions– Toys, bubbles, talking
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Where to and how?
Trauma center FAQ
• What is trauma center?– All resources available for severely injured pt– Levels I - IV
• Why is trauma center important?– Mortality reduction 25% – Shorter length of stay– 24/7 pediatric specialists
Pediatric Trauma Center CriteriaPediatric Trauma Level Criteria (facility and personnel…)
I >200 trauma admissions/yrAt least 2 BC peds surgeon1+ BC peds orthopedic surgeon1+ peds neurosurgeonPICU and 2+ BC Peds critical care physiciansPediatric ED with 2+ BC PEM physiciansMuch MORE…
How we do it.
Resources
• Regional Trauma Advisory Council– http://www.dhs.wisconsin.gov/Trauma/councils/index.htm
• Emergency Medical Services for Children– http://www.dhs.wisconsin.gov/emsc/– http://www.chawisconsin.org– http://www.childrensnational.org/emsc/
summary
• What is killing our children?• Pediatric assessment triangle• Know your resources• You can make a difference