Course Library

Pediatric Trauma

Information Covered:

1. Pediatric fractures
   1. Pathophysiology
      1. Review previous knowledge
      2. Types of fractures
         1. Epiphyseal – at bone growth plate
         2. Greenstick – incomplete fracture from bending bone
         3. Torus – buckling of cortex of bone
      3. Immature growth of bones
      4. Growth plates at end of bones and complications of epiphyseal fractures
   2. Special assessment findings
      1. Review previous knowledge
      2. MOI – assess for abuse
      3. Motor, sensory, pulse assessment distal to injury
      4. Child/parent interaction
      5. Age differences and reaction to trauma
      6. Assess for comorbidity
   3. Special management considerations
      1. Review previous knowledge
      2. AVO
      3. Transport with family members
      4. Consent issues when family not present, injury not serious
      5. Inform family, teachers, guardians of transport location
      6. Immobilization the same as adults
      7. Ice will reduce swelling

1. Pediatric Trauma
   1. Unique Pediatric Aspects of Trauma
   2. Pathophysiology
      1. Head – most common injured
         1. Larger than adults
         2. Large occiput flexes head compromising airway
         3. Suture flexibility in very young
         4. Newborns and infants can become hypotensive with head injuries
      2. Spine
         1. SCIWORA
      3. Chest
         1. Very compliant – injury requires great force
         2. Commotio cordis – sudden impact of blunt force to the chest resulting in cardiac dysfunction, even death
      4. Abdomen
         1. Larger solid organs
         2. Weak abdominal muscles
      5. Musculoskeletal
         1. Epiphyseal plate
         2. Bones heal faster
   3. Special Considerations in assessment
      1. Airway, Breathing, and Circulation
      2. Circulation
         1. Hypotension appears late, use other signs of inadequate circulation
         2. Inadequate oxygenation cause bradycardia
         3. Capillary refill may be helpful
         4. LOC may indicate inadequate circulation
         5. B/P estimated as 80 + 2 times the age
         6. Appropriate B/P cuff size
         7. 80ml/Kg blood loss can cause shock
      3. Head
         1. Very vascular, even scalp laceration can cause shock
         2. Falls less than 5 feet are significant
         3. Beware of shaken baby syndrome
         4. GCS less than 8 means increased ICP
      4. Chest
         1. Significant internal injury can be present without any external signs
         2. Tension-pneumothorax is difficult to evaluate
      5. Abdomen
         1. Spleen most common injured
         2. Cullen’s sign
         3. Kehr’s sign
      6. Musculoskeletal Trauma
   4. Special considerations in management
      1. Airway, Breathing, and Circulation (improper management is the most common cause of preventable pediatric death)
      2. Circulation
      3. Head
      4. Spinal –
         1. adequate size C-collars are important
         2. padding with immobilization
      5. Abdomen
      6. Extremity
      7. Transportation

Content Creator: Chris Hunt
CAPCE Course Number:  21-EMTP-F3-6101
NJ Course Number: 141122
Total CE Hours: 1.5
Level: Basic
EMT-CE uses the NEMSES guidelines as the foundation for every course outline.