Episode 95 Pediatric Trauma

This is Pediatric Trauma on EM Cases. Management of the pediatric trauma patient is challenging regardless of where you work. In this EM Cases episode, with the help of two leading pediatric trauma experts, Dr. Sue Beno from Hospital for Sick Children in Toronto and Dr. Fuad Alnaji from Children's Hospital of Eastern Ontario in Ottawa we answer such questions as: what are the most important physiologic and anatomic differences between children and adults that are key to managing the trauma patient? How much fluid should be given prior to blood products? What is the role of POCUS in abdominal trauma? Which patients require abdominal CT? How do you clear the pediatric c-spine? Are atropine and fentanyl recommended as pre-induction agents in the pediatric trauma patient? How can the BIG score help us prognosticate? Is tranexamic acid recommended in early pediatric trauma like it is in adults? Is the Pediatric Trauma Score helpful in deciding which patients should be transferred to a trauma center? and many more... Podcast production & sound design by Anton Helman. Voice editing by Richard Huang. Written Summary and blog post by Shaun Mehta & Alex Hart, edited by Anton Helman May, 2017. Cite this podcast as: Helman, A, Beno, S, Alnaji, F. Pediatric Trauma. Emergency Medicine Cases. May, 2017. https://emergencymedicinecases.com/episode-99-highlights-emu-2017/. Accessed [date]. Common pitfalls leading to bad pediatric trauma outcomes Failure to: Manage the airway - indicated for almost all severe TBI, any hypoxia Appreciate and treat shock - do not wait for hypotension which is a sign of pre-arrest Prioritize management of injuries - see "CABC" below Check bedside sugar if altered LOC - ABCDEFG "Don't Ever Forget the Glucose" Keep the child warm Preparation before the pediatric trauma patient arrives Use a Broselow tape to draw up all anticipated medications in advance of patient arrival: ketamine 2mg/kg or etomidate 0.3mg/kg, rocuronium 1mg/kg or succinylcholine 1-2mg/kg, fentanyl 2-5mcg/kg, atropine 0.02 mg/kg etc., and to size airway equipment (have one size larger and one size smaller ready as well). Venous access: Prime lines, have IOs ready, central line kit. Warm the room, turn on the overhead warmer (for infants) or Bair hugger (for older children), warm crystalloids, set the rapid infuser. Have pelvic binder or sheet laid out on stretcher with clamps ready. Team huddle: see Andrew Petrosoniak's approach to team-based preparation for a critical event PRIMARY SURVEY PEARLS C-A-B-C: A new paradigm in pediatric trauma ATLS has revently moved from the ABC approach to the CAB for trauma resuscitation. Our experts suggest the  “CABC” approach: First, identify any catastrophic bleeding, then move on to airway and breathing with a plan to return to circulation assessment. In general, respect the range of vital signs in the pediatric population. 90th percentile normal pediatric vital signs HERE Disability: AVPU (Alert, Voice, Pain, Unresponsive) is adequate. Pediatric GCS is also acceptable but not always practical as it is difficult to remember. Exposure: Important in any trauma patient, but keep in mind increased heat loss in children Family Presence: Evidence suggests that family presence reduces stress on families and the patient without compromising team dynamics or med...