Title: Pediatric Trauma for the E.M.S. Current Concepts on Evaluation and Treatment
1Pediatric Trauma for the E.M.S.Current Concepts
on Evaluation and Treatment
- Dr. Donald W. Kucharzyk
- Pediatric Orthopaedic Surgeon
- The Orthopaedic, Pediatric Spine Institute
2Pediatric 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
3Pediatric 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)
4Pediatric 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
5Pediatric 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
6Pediatric 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
7Pediatric 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
8Pediatric 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
9Pediatric 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
10Pediatric 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)
11Pediatric 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
12Pediatric 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
13Pediatric Trauma for the E.M.S.
-
- PEDIATRIC ORTHOPEADIC
- FRACTURE PATTERNS
14Pediatric 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
15Pediatric 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
16Pediatric 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)
17Pediatric 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
18Pediatric 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
19Pediatric Trauma for the E.M.S.
-
- PEDIATRIC ORTHOPEADIC
- COMPLICATIONS
20Pediatric Trauma for the E.M.S.
- PEDIATRIC ORTHOPAEDIC
- FRACTURE PEARLS AND
- WISDOM
21Pediatric 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
22Pediatric 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
23Pediatric Trauma for the E.M.S.
- THANK YOU
- Dr. Donald W. Kucharzyk