5. PEDIATRIC EMERGENCIES
5.10 PEDIATRIC TRAUMA AND TRAUMATIC ARREST
Injury is the most common cause of death in the pediatric population. Blunt injuries, which are usually motor vehicle related, are more common than penetrating injuries, but the latter are unfortunately becoming more common. If a child has multiple injuries or bruises in varying stages of resolution, consider child abuse (see appendix) as a possible etiology. The death rate from traumatic injury in children is two times that of the adult patient. To resuscitate a pediatric traumatic arrest victim, aggressive in-hospital management, often times open thoracotomy, is required. The more prolonged the field time and the transport to the medical facility, the less likely the child is to survive.
ASSESSMENT PRIORITIES
1. Maintain universal blood and body fluid precautions.
2. Determine unresponsiveness, absence of breathing and pulselessness.
3. Maintain an open airway and assist ventilations as needed. This may include repositioning of the airway, suctioning to remove secretions and/or vomitus, or use of airway adjuncts as indicated. Assume spinal injury and treat accordingly.
4. Initiate Cardiopulmonary Resuscitation (CPR) if indicated.
5. Administer 100% high flow oxygen by non-rebreather mask or bag valve mask as indicated by patient's condition.
6. Consider all potential non-traumatic causes (hypothermia, overdose, underlying medical conditions etc.)
7. As patient's condition suggests, continually assess Level of Consciousness, ABCs and Vital Signs.
8. Treat all life threatening conditions as they become identified.
9. When multiple patients are involved, they need to be appropriately triaged.
10. Obtain appropriate history related to event, including Mechanism of Injury, Past Medical History, Medications, Drug Allergies, Substance abuse and child abuse.
11. Patient care activities must not unnecessarily delay patient transport to the nearest appropriate facility as defined by regional point of entry protocol.
TREATMENT
BASIC PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Determine unresponsiveness, absence of breathing and pulselessness.
3. Maintain an open airway and assist ventilations as needed. This may include repositioning of the airway, suctioning to remove secretions and/or vomitus, or use of airway adjuncts as indicated. NOTE: Ventilate at a rate appropriate for age. (See Appendix M)
4. Assume spinal injury and treat accordingly.
5. Initiate treatment for shock (maintain supine position, elevate legs and keep child warm if possible) or initiate Cardiopulmonary Resuscitation (CPR) as indicated.
6. Administer 100% high flow oxygen by non-rebreather mask or bag valve mask as indicated by patient's condition.
7. Consider all potential non-traumatic causes (hypothermia, overdose, underlying medical conditions etc.)
8. Activate ALS intercept, if deemed necessary and if available.
9. As patient's condition suggests, continually assess Level of Consciousness, ABCs and Vital Signs.
10. Treat all life threatening conditions as they become identified.
11. When multiple patients are involved, they need to be appropriately triaged.
12. Initiate transport as soon as possible with or without ALS.
NOTE: Patient care activities must not unnecessarily delay patient transport to the nearest appropriate facility as defined by regional point of entry protocol.
13. EMTs with EMT-MAST credentials may contact MEDICAL CONTROL for utilization of PASG/MAST for any of the following conditions:
a. suspected pelvic fractures
b. splinting of lower extremities
c. to tamponade bleeding from lower extremities.
14. Notify appropriate receiving hospital.
INTERMEDIATE PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Determine unresponsiveness, absence of breathing and pulselessness.
3. Maintain an open airway and assist ventilations as needed. This may include repositioning of the airway, suctioning to remove secretions and/or vomitus, or use of airway adjuncts as indicated. NOTE: Ventilate at a rate appropriate for age. (See Appendix M)
4. Assume spinal injury and treat accordingly.
5. Initiate treatment for shock (maintain supine position, elevate legs and keep child warm if possible) or initiate Cardiopulmonary Resuscitation (CPR) as indicated.
6. Administer 100% high flow oxygen by non-rebreather mask or bag valve mask as indicated by patient's condition.
7. ALS STANDING ORDERS
a. Provide advanced airway management, if indicated.
b. Initiate IV Normal Saline while enroute (KVO).
8. Contact MEDICAL CONTROL. Medical control may order:
a. Fluid bolus of Normal Saline (expected fluid bolus of 20 ml/kg). This order may be repeated at the discretion of medical control.
b. Potential utilization of PASG/MAST for any of the following conditions:
- suspected pelvic fractures.
- splinting of lower extremities.
- to tamponade bleeding from lower extremities.
9. Consider all potential non-traumatic causes (i.e., hypothermia, overdose, other underlying medical conditions, etc.)
10. Activate Paramedic intercept, if deemed necessary and if available.
11. As patient's condition suggests, continually assess Level of Consciousness, ABCs and Vital Signs.
12. Treat all life threatening conditions as they become identified.
13. When multiple patients are involved, they need to be appropriately triaged.
14. Initiate transport as soon as possible with or without Paramedics.
NOTE: Patient care activities must not unnecessarily delay patient transport to the nearest appropriate facility as defined by regional point of entry protocol.
15. Notify appropriate receiving hospital.
PARAMEDIC PROCEDURES
1. Maintain universal blood and body fluid precautions.
2. Determine unresponsiveness, absence of breathing and pulselessness.
3. Maintain an open airway and assist ventilations as needed. This may include repositioning of the airway, suctioning to remove secretions and/or vomitus, or use of airway adjuncts as indicated. NOTE: Ventilate at a rate appropriate for age. (See Appendix M)
4. Assume spinal injury and treat accordingly.
5. Initiate treatment for shock (maintain supine position, elevate legs and keep child warm if possible) or initiate Cardiopulmonary Resuscitation (CPR) as indicated.
6. Administer 100% high flow oxygen by non-rebreather mask or bag valve mask as indicated by patient's condition.
7. ALS STANDING ORDERS
a. Provide advanced airway management.
b. Initiate IV Normal Saline (1 - 2 large bore IVs)
c. Administer fluid bolus of Normal Saline (20 ml/kg) and titrate IV infusion rate to patient's hemodynamic status depending upon age/size/weight of child.
d. If the child is in cardiopulmonary arrest and unable to establish vascular access, and the child is less than 6 years old, establish an Intraosseous Infusion of Normal Saline and administer 20 cc/kg fluid bolus. NOTE: In general, the only medications that should be administered to a traumatic arrest patient are oxygen and IV fluids.
e. If in cardiopulmonary arrest, no IV access and the child is greater than six years old, attempt external jugular access and administer 20 cc/kg fluid bolus.
f. Utilization of PASG/MAST for any of the following conditions:
- suspected pelvic fractures
- splinting of lower extremities
- to tamponade bleeding from lower extremities.
8. Contact MEDICAL CONTROL. Medical control may order :
a. Needle cricothyroidotomy
b. Additional bolus(es) 20 cc/kg of Normal Saline or wide open (depending upon child’s age/size/weight).
d. Needle decompression of the thorax if indicated.
9. Consider all potential non-traumatic causes (hypothermia, overdose, underlying medical conditions etc.)
10. As patient's condition suggests, continually assess Level of Consciousness, ABCs and Vital Signs.
11. Treat all life threatening conditions as they become identified.
12. When multiple patients are involved, they need to be appropriately triaged.
13. Initiate transport as soon as possible. Note: Above activities must not unnecessarily delay patient transport to the nearest appropriate facility as defined by regional point of entry protocol.
14. Notify appropriate receiving hospital.
MoonDragon's EMS Index Page
HELPFUL PRODUCTS & FURTHER EDUCATION
-- by Phyllis A. Balch, James F. Balch - 2nd Edition
-- by Phyllis A. Balch, James F. Balch - 4th Edition
-- by Phyllis A. Balch
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