Pediatric Chest and Abdominal Trauma: Pearls of Management

45 Pages·2012·5.08 MB·English

Pediatric Chest and Abdominal
Trauma: Pearls of Management
Judith R. Klein, MD, FACEP
Assistant Professor of Emergency Medicine
UCSF-SFGH Emergency Medicine
Sunday, January 22, 2012
Johnny Walker
Ring down: 4 yo pedestrian vs. auto with LOC
P 120; BP 80/60; RR 25, crying
Airway patent
Chest mild TTP/no distress
CRT=3 seconds
Abdomen NTTP/bruising
Awake, alert, crying
Sunday, January 22, 2012
Critical Issues
What are important anatomic and physiologic
differences between kids and adults with chest and
abdominal trauma?
Which imaging tests are indicated for kids with
blunt trauma? Plain films? US? CT?
What injuries do kids get?
What is the appropriate management of kids with
IAI? What if the CT’s are negative?
Sunday, January 22, 2012
Pediatric Trauma: The
Problem
Leading cause of death/disability
in kids 1-18 years
50% of all deaths under 15 years
Per year:
1.5 million injuries
500K hospitalizations
20K deaths
Sunday, January 22, 2012
Why are kids so
vulnerable?
Smaller bodies-->force of trauma
distributed more widely-->more
injuries
#1 Inappropriate restraint in MVC:
New AAP recommendations
#2 PVA: <5 years old or >30mph
#3 Height of fall: predicts head/ortho
not as much chest/abdominal injury
Sunday, January 22, 2012
Differences in injury
patterns: Chest
More pliable rib cage: ribs bend
-->less protection for thorax-->
pulmonary contusions (#1)
Immature intercostals/pliable rib cage
-->earlier respiratory failure
Aorta/mediastinum/diaphragm
injuries VERY uncommon
More mobile mediastinum-->tension
pneumothorax
Sunday, January 22, 2012
Differences in injury
patterns: Abdomen
Liver/spleen/kidney not
well protected by ribs/muscles
Better vasoconstrictive response
Solid organ bleeding tends to stop
Pitfall of hypotension
Sunday, January 22, 2012
Shock in kids
CRT>2-3 seconds/cool skin
Low urine output
AMS
HR /narrow pulse pressure
Lactate>3-4
DON’T wait for hypotension
Sunday, January 22, 2012
Approach to Johnny
Walker
A: Patent
B: Nl RR/no distress/mild TTP
C: BP 80/60; P125; CRT=3 sec,
lactate=7! IV/Fluids
D: Alert, crying; hx LOC
E: Naked! Cover him up!
Sunday, January 22, 2012
What’s next?
Radiation!
4 million CT’s in kids 2007
700% increase in CT’s in 10 years
Most radiosensitive organs:
Bone marrow, breast, thyroid, lung
Sunday, January 22, 2012