Advanced Trauma Life Support ATLS Student Course Manual 2018

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CHAPTER 10 n Pediatric Trauma
Injury remains the most common cause of death
and disability in childhood. Each year, more than 10
million children—nearly 1 of every 6 children—in
the United States require emergency department care
for the treatment of injuries. Each year, more than
10,000 children in the United States die from serious
injury. Injury morbidity and mortality surpass all major
diseases in children and young adults, making trauma
the most serious public health and healthcare problem
in this population. Globally, road traffic accidents
are the leading cause of adolescent deaths. Failure
to secure a compromised airway, support breathing,
and recognize and respond to intra-abdominal and
intracranial hemorrhage are the leading causes of
unsuccessful resuscitation in pediatric patients with
severe trauma. Therefore, by applying ATLS principles
to the care of injured children, trauma team members
can significantly affect ultimate survival and longterm
outcomes.
Types and PatteRNs of Injury
Injuries associated with motor vehicles are the most
common cause of death in children of all ages, whether
they are occupants, pedestrians, or cyclists. Deaths due
to drowning, house fires, homicides, and falls follow
in descending order. Child maltreatment accounts
for the great majority of homicides in infants (i.e.,
children younger than 12 months of age), whereas
firearm injuries account for most of the homicides in
children (over age 1) and adolescents. Falls account for
the majority of all pediatric injuries, but infrequently
result in death.
Blunt mechanisms of injury and children’s unique
physical characteristics result in multisystem injury
being the rule rather than the exception. Clinicians
should presume, therefore, that multiple organ systems
may be injured until proven otherwise. n TABLE 10-1
outlines common mechanisms of injury and associated
patterns of injury in pediatric patients.
The condition of the majority of injured children
will not deteriorate during treatment, and most
injured children have no hemodynamic abnormalities.
Nevertheless, the condition of some children
with multisystem injuries will rapidly deteriorate,
and serious complications will develop. Therefore,
early transfer of pediatric patients to a facility capable
of treating children with multisystem injuries
is optimal.
The Field Triage Decision Scheme (see Figure 1-2 in
Chapter 1) and Pediatric Trauma Score n TABLE 10-2 are
both useful tools for the early identification of pediatric
patients with multisystem injuries.
table 10-1 common mechanisms of
injury and associated patterns of
injury in pediatric patients
MECHANISM
OF INJURY
Pedestrian struck
by motor vehicle
Occupant in
motor vehicle
collision
Fall from a height
Fall from a
bicycle
COMMON PATTERNS
OF INJURY
• Low speed: Lower-extremity
fractures
• High speed: Multiple trauma,
head and neck injuries, lowerextremity
fractures
• Unrestrained: Multiple trauma,
head and neck injuries, scalp and
facial lacerations
• Restrained: Chest and abdominal
injuries, lower spine fractures
• Low: Upper-extremity fractures
• Medium: Head and neck injuries,
upper- and lower-extremity
fractures
• High: Multiple trauma, head and
neck injuries, upper- and lowerextremity
fractures
• Without helmet: Head and neck
lacerations, scalp and facial lacerations,
upper-extremity fractures
• With helmet: Upper-extremity
fractures
• Striking handlebar: Internal
abdominal injuries
Unique ChARActeristics
of Pediatric Patients
The priorities for assessing and managing pediatric
trauma patients are the same as for adults. However,
the unique anatomic and physiologic characteristics
of this population combine with the common
mechanisms of injury to produce distinct injury
patterns. For example, most serious pediatric trauma
is blunt trauma that involves the brain. As a result,
apnea, hypoventilation, and hypoxia occur five times
more often than hypovolemia with hypotension in
children who have sustained trauma. Therefore,
treatment protocols for pediatric trauma patients
emphasize aggressive management of the airway
and breathing.
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