The main causes of serious injury in children are due to motor vehicle accidents and falls.
Injury prevention is the biggest factor in reducing trauma mortality but unfortunately children still continue to be injured.
Primary assessment and early <c>ABC interventions will avoid some deaths and prevent late complications in children involved in major trauma.
At PMH, a trauma team consisting of staff from the Emergency Department, Paediatric Intensive Care Unit (PICU), surgical and anaesthetic teams manage major trauma as defined by mechanism of injury and physiological parameters.
This multidiscplinary trauma team will follow a structured approach to manage seriously injured patients.
This structured approach initially focuses on identifying and treating immediate threats to life – the primary survey.
Following this initial primary survey and resuscitation, the structured approach is again used as a secondary survey to identify other key injuries which require emergency treatment to stabilise the patient and prevent secondary insult.
It is recommended that all healthcare workers who work with injured children undertake an Advanced Paediatric Life Support (APLS), Emergency Management of Severe Trauma (EMST) course or similar to provide the skills needed to assess and manage seriously injured children.
A structured, systematic approach is essential when assessing seriously injured children.
Primary survey using an “<c>ABCD” approach is a simple and highly effective method in major trauma.
Assume cervical spine injury in all trauma patients.
Treat problems immediately as thay are found during the primary survey, before moving on.
A detailed history of the incident should be sought including:
Mechanism of injury
Time of injury
The primary survey involves a rapid structured assessment of <c>atastrophic haemorrhage, Airway, Breathing, Circulation, Disability and Exposure.
Treat life threatening issues immediately as they are discovered during the primary survey before moving on.
Control obvious external haemorrhage – apply pressure.
Airway and C Spine
Assume C-Spine injury in any major trauma patient
Immobilise C-Spine in a hard collar or manual in-line immobilisation
Assess airway patency and signs of obstruction
Bruising or swelling
Suction if necessary
Jaw thrust (head tilt is contraindicated if there is suspicion of C-Spine injury)
Oropharyngeal airway (nasopharyngeal airway containdicated if there is suspicion of a base of skull fracture)
Breathing & Ventilatory Support
Fully expose the neck and chest Look, listen and feel Provide oxygen via a non-rebreather mask with a reservoir
Symmetry of chest expansion
Effort – nasal flare, recession, accessory muscle use
Effects – heart rate, skin colour, mental state
Urgently exclude and treat:
Bag valve mask ventilation
Intubation and positive pressure ventilation
Consider an oro-gastric tube
!6 G needle into 2ICS if suspect pneumothorax
3 way occlusive dreesing for tension pneumothorax (while preparing for drain0)
Circulation & Haemorrhage Control
Obvious external haemorrhage
Distended neck veins
Muffled heart sounds
Signs of shock
Central capillary return
Two large bore cannulae (take blood for FBC and cross match)
Fluid resuscitation – 10ml/kg of warmed 0.9% saline and repeat if necessary
Consider Blood as initial resuscitation fluid if uncontrolled haemorrhagic shock