Pediatric Chest and Abdominal Trauma: Pearls of Management PDF
Preview Pediatric Chest and Abdominal Trauma: Pearls of Management
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
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