Topics Discussed: acute illness; multiple trauma.
Sections: Evaluation and Management of the Multiple Trauma Patient: Introduction, Nature of Injuries and Unique Pediatric Aspects, Pediatric Trauma Systems, Prehospital Care Issues, Initial Assessment and Management Guidelines for the Injured Child, Resuscitation, Secondary Survey and Definitive Care, Injury Severity Measures, Disposition/Transfer, References.
- Injury is the leading cause of death of children in the United States.
- Children have physiologic and psychologic responses to trauma that are different from those seen in adults.
- The airway is secured while concomitantly stabilizing the neck. The jaw thrust maneuver is used to open the airway and the oropharynx is cleared of debris and secretions.
- Orotracheal intubation is the most reliable means of securing an airway. An uncuffed tube should be used in children <8 years of age.
- Hypovolemic shock is caused by blood loss, which makes up 8% to 9% of the body weight of a child. Determining the extent of volume depletion and shock is difficult in children and multiple parameters must be used.
- Vascular access is difficult under the best of circumstances and can be a reason for delay in transport of a critically ill child. Attempt vascular access en route to avoid prolonged stay at the scene. Intraosseous infusion should be used as a quick access for crystalloid infusion if attempts at intravenous cannulation are unsuccessful after 90 seconds.
- For shock, the initial resuscitative fluid is isotonic crystalloid solution, such as normal saline or Ringer's lactate. Give an initial infusion of 20 mL/kg as rapidly as possible.
- Urinary output may help assess perfusion and intravascular status. Insert a Foley catheter and monitor urinary output as follows: 1 mL/kg/h for..."
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