Pediatric Trauma2014 Emergency Care Trauma Symposium

June 24, 2014

Michael Kim, MD

objectives

• Epidemiology• Resources• Pediatric Assessment Triangle• Trauma approach • Destination: how and where?

Pediatric Trauma• Leading cause of death: 1-15 yr• 22 million injured / yr• 9.2 million ED visits• 20K deaths / yr• 50K permanent disabilities

• Economic impact: $10,000,000,000 per year

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Injury PreventionYou can make a difference !

Resources for optimal prehospital care

• Training • Equipment• Support and resources

EMS pediatric education / exposure

• BLS training in pediatrics: 8 hrs• ALS training in pediatrics: 16 hrs• Percentage of pediatric runs: 10%• % of all peds runs requiring ALS: 12 %• BMV: 1 in every 1.7 years• ETT: 1 in 3.3 years• IO placement: 1 in 6.7 years

Pediatric and trauma training

Pediatric and trauma training

Anatomy

• Not just smaller• Bigger head• Airway• Musculoskeletal• Organ proportions• Greater surface to volume

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The percent of patient care units in the State/Territory that have the essential pediatric equipment and supplies as outlined in national guidelines.

EMSC Performance Measure 73

2010 EMSC Program

The percent of patient care units in the State/Territory that have the essential pediatric equipment and supplies as outlined in national guidelines.

Wisconsin BLS PCUs: 57/203= 28% (National Average 23%)ALS PCUs: 81/353 = 23% (National Average 34%)

EMSC Performance Measure 73

2010 EMSC Program

WI EMSC Pediatric Jump Kit

Resources

• 9 y/o missing for 30 min • found face down next to rolled over ATV• no protective equipment• active hemorrhage from scalp• PNB at the scene

Approach to trauma patient

• Airway• Breathing• Circulation• Disability• Exposure/Environment

Initial Assessment

Airway• Normal speech & crying• Talking?• Crying?• Airway noises• Stridor

Appearance• AVPU• A &O• Confused• Irritable• GCS

Respiratory effort• Retraction• Rate• Nasal flaring • Grunting• Gasping• Abdominal breathing• Wheeze• Pulse oximetry• Endtidal CO2Circulation

• Heart rate• Hypotension• Mental status• Cyanosis• Pale• Cool to touch• Weak pulse• Poor capillary refill

Disability

Pediatric GCS

Intervention?

• No resp effort• No pulse• Cyanotic

• No movement

Interventions

Respiratory effort• Supplemental oxygen• PEEP• + pressure ventilation

Circulation• Stop hemorrhage• Temperature• Fluid resuscitation

Airway• Open airway• Jaw thrust (c-spine)• Oral airway• Maintainable?

Appearance• Stimulate • Interact• Support/console

Airway and Breathing

Circulation

• assessment • intervention

Next

• Disability (Dexi)– Glasgow Coma Scale

(age appropriate)– Brief neurologic eval– Splint and immobilize

• Exposure– Head to toe look see– Temperature control

Development and emotional

• Age dependent abilities and understanding– Stranger anxiety– Crying– Attitude– Reaction to…

• Intervention– Parental presence– No surprises– Distractions– Toys, bubbles, talking

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Where to and how?

Trauma center FAQ

• What is trauma center?– All resources available for severely injured pt– Levels I - IV

• Why is trauma center important?– Mortality reduction 25% – Shorter length of stay– 24/7 pediatric specialists

Pediatric Trauma Center CriteriaPediatric Trauma Level Criteria (facility and personnel…)

I >200 trauma admissions/yrAt least 2 BC peds surgeon1+ BC peds orthopedic surgeon1+ peds neurosurgeonPICU and 2+ BC Peds critical care physiciansPediatric ED with 2+ BC PEM physiciansMuch MORE…

How we do it.

Resources

• Regional Trauma Advisory Council– http://www.dhs.wisconsin.gov/Trauma/councils/index.htm

• Emergency Medical Services for Children– http://www.dhs.wisconsin.gov/emsc/– http://www.chawisconsin.org– http://www.childrensnational.org/emsc/

summary

• What is killing our children?• Pediatric assessment triangle• Know your resources• You can make a difference