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Trauma

Pediatric MULTIPLE TRAUMA

Signs and Symptoms: Possible Injuries / Diagnoses:
• Pain, Swelling, Bleeding • Tension Pneumothorax • Head Injury
• Ecchymosis • Flail Chest • Extremity Fracture/D Dislocation
• Deformity • Pericardial Tamponade • HEENT Injuries
• Altered Mental Status • Open Chest Wound • Hypothermia
• Respiratory Distress/Failure • Hemothorax • Burns
• Vomiting • Intra-abdominal Injury/Bleeding
• Hypotension/Shock • Pelvis/Long-bone Fracture
• Cardiac Arrest • Spine/ /Spinal Cord Injury
Continued from: Consider early airway
Tactical Evacuation Guideline HEMORRHAGE CONTROL management per Respirations Abnormal
• Check / Add Tourniquet Airway and Chest • Reposition Airway / OPA
• PEDs AIRWAY GUIDELINE
Rapid Assessment with GCS • Pack and Dress Wound Trauma Guidelines o Nasopharyngeal Airway
• Pressure Dressing
Concentration on C, A, B o Intubation
• Hemostatic Dressing Spinal o Cricothyroidotomy
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Minimize On-Scene Time • Treatment Order by Immobilization prn r n
Severity of Hemorrhage
IV/IO GUIDELINE Chest Injury (Impacts Breathing)
TXA if: Hemorrhage with ↑HR or ↓SBP Average • CHEST TRAUMA GUIDELINE
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Vital Signs/GGLUCOSE o Needle Thoracostomy
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Pediatric HYPOTENSION / SHOCK GUIDELINE o Tube Thoracostomy
• WB, 1:1:1, or pRBC’s (if available) (Blood Guideline) Abnormal Normal o Positive Pressure Ventilation
• Bolus ALL FLUIDS
• 10mL/kg Blood Bolus in <20 min.
• 20mL/kg IVF if blood not available

ENSURE Fractures are Stable: Head Injury Guideline
• Reduction / Compression of pelvic fractures Altered Mental Status
or MOI c/w Head or
• Reduction of long bone (Femur) fractures Spinal Injury
• Reassess Control of External Hemorrhage
(Continued Decompensation) Abnormal Vital Signs / Perfusion? Normal
Restart Guideline Pediatric PAIN MANAGEMENT
Check and Readdress: GUIDELINE
• Hemorrhage control Loss of Circulation at any time: Start CPR (Hemodynamic &
• Airway: Respiration rate, O2, and Sats 100-120 Comp/Min Mental Status Stable)
• Breathing: Equal Rise/Fall, Bruising, Tracheal • 1 Rescuer: 30 Compressions to 2 Breaths
shift, Sub-Q Emphysema • 2 Rescuer: 15 Compressions to 2 Breaths
• IV/IO lines open and running Move to: TRAUMA ARREST Guideline Return to:
• Pelvic/Femur FXs reduced and stable Tactical Evacuation
• Head and/or Spinal Injury Guideline
Pearls:
• Resuscitation: Maintain, SBP to at least [70 + 2 x age (yr)] or to mental status change.

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• N Normotesion: [90 + 2 x age (yr)] ) ]
• Narrowed pulse pressure should prompt resuscitation – do not wait for decompensation to ensue.
• Stabilize pelvic fractures with Pelvic Splint or sheet / binder and tie feet together. Up to 80% of blood volume can be hidden
in the pelvis.
• Follow Length Based Resuscitation Tape for Pediatric ALS Equipment.
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