Advanced Trauma Life Support ATLS Student Course Manual 2018

190
CHAPTER 10 n Pediatric Trauma
child are more likely to establish a good rapport, which
facilitates a comprehensive assessment of the child’s
psychological and physical injuries.
The presence of parents or other caregivers during
evaluation and treatment, including resuscitation,
may assist clinicians by minimizing the injured child’s
natural fears and anxieties.
Long-Term Effects of Injury
A major consideration in treating injured children is
the effect of that injury on their subsequent growth
and development. Unlike adults, children must recover
from the traumatic event and then continue the normal
process of growth and development. The potential
physiologic and psychological effects of injury on
this process can be significant, particularly in cases
involving long-term function, growth deformity, or
subsequent abnormal development. Children who
sustain even a minor injury may have prolonged
disability in cerebral function, psychological adjustment,
or organ system function.
Some evidence suggests that as many as 60% of
children who sustain severe multisystem trauma have
residual personality changes at one year after hospital
discharge, and 50% show cognitive and physical
handicaps. Social, affective, and learning disabilities
are present in one-half of seriously injured children.
In addition, childhood injuries have a significant
impact on the family—personality and emotional
disturbances are found in two-thirds of uninjured
siblings. Frequently, a child’s injuries impose a strain on
the parents’ personal relationship, including possible
financial and employment hardships. Trauma may
affect not only the child’s survival but also the quality
of the child’s life for years to come.
Bony and solid visceral injuries are cases in point:
Injuries through growth centers can cause growth
abnormalities of the injured bone. If the injured bone
is a femur, a leg length discrepancy may result, causing
a lifelong disability in running and walking. If the
fracture is through the growth center of one or more
thoracic vertebra, the result may be scoliosis, kyphosis,
or even gibbus deformity. Another example is massive
disruption of a child’s spleen, which may require a
splenectomy and predisposes the child to a lifelong risk
of overwhelming postsplenectomy sepsis and death.
Ionizing radiation, used commonly in evaluation
of injured patients may increase the risk of certain
malignancies and should be used if the information
needed cannot obtained by other means, the information
gained will change the clinical management of the
patient, obtaining the studies will not delay the
transfer of patients who require higher levels of care,
and studies are obtained using the lowest possible
radiation doses.
Nevertheless, the long-term quality of life for
children who have sustained trauma is surprisingly
positive, even though in many cases they will experience
lifelong physical challenges. Most patients
report a good to excellent quality of life and find
gainful employment as adults, an outcome justifying
aggressive resuscitation attempts even for pediatric
patients whose initial physiologic status might
suggest otherwise.
Equipment
Successful assessment and treatment of injured
children depends on immediately available equipment
of the appropriate size (n TABLE 10-3; also see Pediatric
Equipment on MyATLS mobile app). A length-based
resuscitation tape, such as the Broselow® Pediatric
Emergency Tape, is an ideal adjunct for rapidly
determining weight based on length for appropriate
fluid volumes, drug doses, and equipment size. By
measuring the child’s height, clinicians can readily
determine his or her ’estimated weight. One side of the
tape provides drugs and their recommended doses for
pediatric patients based on weight, and the other side
identifies equipment needs for pediatric patients based
on length (n FIGURE 10-1). Clinicians should be familiar
with length-based resuscitation tapes and their uses.
Pitfall
Incorrect doses of
fluids or medications
are administered
Hypothermia rapidly
develops
Airway
prevention
• Recognize the need for
weight-based dosing, and
use a resuscitation tape to
estimate weight from length.
• Recognize the significance
of a high body surface area
in children, and keep the
environment warm and the
child covered.
The “A” of the ABCDEs of initial assessment is the
same in the child as for adults. Establishing a patent
airway to provide adequate tissue oxygenation is
the first objective. The inability to establish and/or
maintain a patent airway with the associated lack
of oxygenation and ventilation is the most common
n BACK TO TABLE OF CONTENTS