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Pediatric Trauma for the E.M.S. Current Concepts on Evaluation and Treatment

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Pediatric Trauma for the E.M.S. Current Concepts on Evaluation and Treatment Dr. Donald W. Kucharzyk Pediatric Orthopaedic Surgeon The Orthopaedic, Pediatric & Spine ... – PowerPoint PPT presentation

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Title: Pediatric Trauma for the E.M.S. Current Concepts on Evaluation and Treatment


1
Pediatric Trauma for the E.M.S.Current Concepts
on Evaluation and Treatment
  • Dr. Donald W. Kucharzyk
  • Pediatric Orthopaedic Surgeon
  • The Orthopaedic, Pediatric Spine Institute

2
Pediatric Trauma for the E.M.S.
  • Approach to the Polytrauma Patient
  • Identify the Most Common Pediatric Orthopaedic
    Fractures
  • Assess and Institute appropriate Initial
    Treatment Plans
  • Identify Potential Complications and Appropriate
    Treatment Initiatives

3
Pediatric Trauma for the E.M.S.
  • POLYTRAUMA
  • Primary Cause of Serious Injuries in Childhood
  • 45 caused by automobiles (15 passenger and 30
    pedestrian)
  • 40 caused by falls
  • 100,000 children are crippled
  • 15,000 children die (accounts for one half the
    deaths in those under 15 years)

4
Pediatric Trauma for the E.M.S.
  • 50 have associated head injury
  • 30-50 have an extremity injury
  • 42 have an injury to the spine
  • 25 have an injury to the chest
  • 15 have abdominal injury
  • WADDELLS TRIAD fracture of the femur, injury to
    the thorax on the same side, and contralateral
    head injury

5
Pediatric Trauma for the E.M.S.
  • INITIAL EVALUATION
  • Evaluate the Status of the Airway
  • Identify for the Presence of Hemorrhage and Shock
  • Determine the State of Consciousness
  • Evaluate for Internal Injuries
  • Evaluate the Spine
  • Evaluate the Extremities

6
Pediatric Trauma for the E.M.S.
  • Maintenance of Airway may require intubation
  • Establish IV access
  • Maintain Arterial Blood Pressure
  • Insert Nasogastric Tube
  • Cardiac Monitoring
  • Spinal Immobilization

7
Pediatric Trauma for the E.M.S.
  • Establish Appropriate Vascular Status of the
    Extremities
  • Assess Extremities for Fractures and Dislocations
  • Splint Extremity Injuries
  • Transport to Emergency Medical Facility

8
Pediatric Trauma for the E.M.S.
  • SPINAL IMMOBILIZATION
  • Spinal Injuries
  • 24 incidence of multi-level injuries
  • Children under 6 years immobilize with the split
    mattress technique to elevate the thorax and
    lower the occiput
  • Routine immobilization of Children older than 6
    years

9
Pediatric Trauma for the E.M.S.
  • Reason for difference in immobilization children
    have larger heads and increased incidence of
    kyphosis and anterior translation of upper
    cervical segments
  • Stabilize the remaining Spinal Injuries via
    routine Back Board Immobilization

10
Pediatric Trauma for the E.M.S.
  • EXTREMITY EVALUATION
  • Assess Circulatory Status via evaluation of
    presence of pulse, color, and capillary filling
  • Assess for Deformity, Angulation, Excessive
    Motion, and Crepitance
  • Neurologic Assessment if possible (may be
    difficult in pediatric patient, attempt to see
    response to stimulation)

11
Pediatric Trauma for the E.M.S.
  • Splint Extremity in Position of Comfort
  • Upper Extremity Long Arm Splint
  • Shoulder Sling and Swathe
  • Femur Hare Traction Splint
  • Lower Extremity Long Leg Splint
  • Always re-assess the status of the circulation
    and neurologic of the extremity

12
Pediatric Trauma for the E.M.S.
  • ASSOCIATED INJURIES
  • Head Injuries 90 with heqd injuries recover
    from a coma in 48 hours.
  • Glasgow Coma Scale important scores of over 5
    tend to recover fully.
  • Chest Injuries 97 caused by blunt trauma with
    68 having associated orthopaedic injuries 50
    have pulmonary contusions 37 incidence
    pneumothorax

13
Pediatric Trauma for the E.M.S.
  • PEDIATRIC ORTHOPEADIC
  • FRACTURE PATTERNS

14
Pediatric Trauma for the E.M.S.
  • Pediatric Upper Extremity
  • Humeral Fractures usually Growth Plate Injuries
  • Elbow Dislocations rare under 4 years old Think
    Transepiphyseal Fracture Dislocations go
    Lateral, Fractures go Medial
  • Elbow Fractures Think Supracondylar

15
Pediatric Trauma for the E.M.S.
  • Pediatric Upper Extremity
  • Supracondylar Fracture Evaluate for Compartment
    Syndrome if Severe Pain
  • Forearm Fractures Watch for Swelling
  • Wrist Fractures Watch for Neurologic and
    Compartment Syndrome

16
Pediatric Trauma for the E.M.S.
  • Pediatric Lower Extremity
  • Hip Fractures Severe Injury End Result Poor
    Externally Rotated as Adult Internally Rotated
    Dislocated
  • Femur Fractures High Blood Loss Potential and
    also Vascular/Neurologic injuries
  • Knee Injuries Think Distal Femur Fracture
    (Growth Plate)

17
Pediatric Trauma for the E.M.S.
  • Pediatric Lower Extremity
  • Knee Ligamentous Injury Rare
  • Knee Dislocation Rare
  • Tibial Fractures Think Potential Compartment
    Syndrome
  • Ankle Fractures Usually Growth Plate Injuries
  • Ankle Dislocations Rare

18
Pediatric Trauma for the E.M.S.
  • Pediatric Lower Extremity
  • Ankle Fractures Complex and MultiPlanar Growth
    Plate Injuries
  • Foot Injuries May be Crush Injury and Think
    Compartment Syndrome
  • Lower Extremity Injuries can be associated with
    Soft Tissue Involvement and Associated with
    Compartment Syndrome

19
Pediatric Trauma for the E.M.S.
  • PEDIATRIC ORTHOPEADIC
  • COMPLICATIONS

20
Pediatric Trauma for the E.M.S.
  • PEDIATRIC ORTHOPAEDIC
  • FRACTURE PEARLS AND
  • WISDOM

21
Pediatric Trauma for the E.M.S.
  • Pediatric Patients are NOT LITTLE Adults and
    cant be treated as such
  • Multitude of Growth Plates make even simple
    injuries sometimes severe long term problems
  • Always Splint the Fracture Above and Below the
    affected area and constantly assess vascular and
    neurologic
  • Watch Out for Compartment Syndrome

22
Pediatric Trauma for the E.M.S.
  • Pediatric Injuries can Affect Multiple Areas and
    can have Multiple Organ System involvement and
    Injuries
  • Spinal Immobilization Different than Adult or
    Older Child Watch Age for Type of Immobilization
  • With Spinal Injuries When in Doubt Immobilize
    and Protect Against Injury

23
Pediatric Trauma for the E.M.S.
  • THANK YOU
  • Dr. Donald W. Kucharzyk
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