Advanced Trauma Life Support ATLS Student Course Manual 2018

208
CHAPTER 10 n Pediatric Trauma
••
Retinal hemorrhages
••
Bizarre injuries, such as bites, cigarette burns,
and rope marks
••
Sharply demarcated second- and third-degree burns
••
Skull fractures or rib fractures seen in children
less than 24 months of age
In many nations, clinicians are bound by law to
report incidents of child maltreatment to governmental
authorities, even cases in which maltreatment is only
suspected. Maltreated children are at increased risk
for fatal injuries, so reporting is critically important.
The system protects clinicians from legal liability
for identifying confirmed or even suspicious cases
of maltreatment.
Although reporting procedures vary, they are most
commonly handled through local social service agencies
or the state’s health and human services department.
The process of reporting child maltreatment assumes
greater importance when one realizes that 33% of
maltreated children who die from assault in the United
States and United Kingdom were victims of previous
episodes of maltreatment.
Prevention
The greatest pitfall related to pediatric trauma is failure
to have prevented the child’s injuries in the first place. Up
to 80% of childhood injuries could have been prevented
by the application of simple strategies in the home
and community. The ABCDE’s of injury prevention
have been described, and warrant special attention
in a population among whom the lifetime benefits of
successful injury prevention are self-evident (n BOX 10-1).
box 10-1 abcdes of injury prevention
• Analyze injury data
– Local injury surveillance
• Build local coalitions
– Hospital community partnerships
• Communicate the problem
– Injuries are preventable
• Develop prevention activities
– Create safer environments
• Evaluate the interventions
– Ongoing injury surveillance
Source: Pressley JC, Barlow B, Durkin M, et al. A national program for
injury prevention in children and adolescents: the injury free coalition
for kids. J Urban Health 2005; 82:389–401.
Not only can the social and familial disruption associated
with childhood injury be avoided, but for every dollar
invested in injury prevention, four dollars are saved in
hospital care.
TeamWORK
The care of severely injured children presents many
challenges that require a coordinated team approach.
Ideally, injured children are cared for in settings that
have a pediatric trauma team composed of a physician
with expertise in managing pediatric trauma, pediatric
specialist physicians, and pediatric nurses and staff.
Team members should be assigned specific tasks
and functions during the resuscitation to ensure an
orderly transition of care.
The reality is that most injured children will initially
be treated in a facility with limited pediatric specialty
resources. An adult trauma team may be responsible
for the care of injured children and must provide
the following:
••
A trauma team leader who has experience in
the care of injured patients and is familiar with
the local medical resources available to care for
injured children
••
A provider with basic airway management skills
••
Access to providers with advanced pediatric
airway skills
••
Ability to provide pediatric vascular access via
percutaneous or intraosseous routes
••
Knowledge of pediatric fluid resuscitation
••
Appropriate equipment sizes for a range of
different ages
••
Strict attention to drug doses
••
Early involvement of a surgeon with pediatric
expertise, preferably a pediatric surgeon
••
Knowledge and access to available pediatric
resources (pediatrician, family medicine) to
help manage pediatric-specific comorbidities
or issues
••
Inclusion of the child’s family during the
emergency department resuscitation and
throughout the child’s hospital stay
••
It is particularly important to debrief after a
pediatric trauma case. Team members and
n BACK TO TABLE OF CONTENTS