Page 24 - 2023 SMOG Digital

Trauma

Pediatric HYPOTENSION /

SHOCK
Signs and Symptoms: Differential Diagnosis:
• Restlessness/Confusion • Shock: Hypovolemic, Cardiogenic, Septic,
• Weakness/Dizziness Neurogenic, Anaphylactic
• Tachycardia • Cardiac Arrhythmia
• Pale, Cool, Clammy Skin • Pulmonary Embolus
• Delayed Capillary Refill • Tension Pneumothorax
• Hypotension • Medication Effect/OD
• Nausea / Vomiting • Vasovagal Episode
• Responsiveness / Lethargy • Dehydration
• Congenital Heart Disease

Continued from:
Tactical Evacuation Guideline
Tactical IV/IO GUIDELINE
Evacuation
Guideline • Supplemental O2
NO Symptomatic?
Trauma YES Cardiac
Non-trauma & Non-cardiac Treat per appropriate Cardiac
Trauma Fluid Preferences Guideline:
• Whole Blood (if available) 20mL/kg IVF Bolus • Pediatric BRADYCARDIA w Pulse
• pRBCs and plasma (if and Poor Perfusion
available) No Response/Losing BP Control? • Pediatric TACHYCARDIA w Pulse
and Poor Perfusion
• (LR/NS) 20mL/kg IVF Bolus • Pediatric CARRDIAC ARREST

Consider EPINEPHRINE
1mcg/kg/min IV/IO NO Rales heard on Lung Exam?
YES
10mL/kg blood product OR
NOREPINEPHRINE Non-Invasive PPV (BVM) vs. Pediatric
0.05-0.1mcg/kg/min IV/IO Advanced Airway AIRWAY
No Response / Losing BP Control? (Max 2mcg/kg/min)
5-10mL/kg IVF over 5-10 min
Consider (as LAST Resort): At Any Point, Once BP Controlled: No Response/Losing BP
EPINEPHRINE 1mcg/kg/min IV/IO • Continuous Monitoring Control?
OR Reassess q5min
Norepinephrine 0.05-0.1mcg/kg/min • Return to: Consider EPINEPHRINE
SLOW IV/IO Push q10-15min Tactical Evacuation Protocol 1mcg/kg/min IV/IO
Pearls:
• Hypotension in pediatric patients is defined as a SBP less than 70 + [2 x age (yr)].
• Decreasing heart rate with worsening neuro or clinical exam may be a sign of impending collapse in pediatric patients
• Consider all the causes of shock and treat per appropriate protocol.
• Avoid Pressors as able (unless distributive or cardiogenic shock) Continue IVFs for trauma: Optimize hemostasis and correct volume
loss.

24