Pediatric Trauma Management Guidelines
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Muhammed ElgasimPediatric Trauma Management Guidelines
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Muhammed ElgasimStructured Approach to the Seriously Injured Child
Pre-Arrival Preparation
• Receive trauma alert using ATMISTER mnemonic:
o Age/Sex
o Time of incident
o Mechanism of injury
o Injuries suspected
o Signs (vital signs, GCS)
o Treatment given
o ETA
o Requirements (e.g. bloods, CT, specialist support)
• Brief trauma team using STEP UP:
o Self-prepare
o Team roles clarified
o Environment set up
o Patient/Primary survey focus
o Update with current status
o Plan ahead (imaging, procedures, transfer)
• Activate Paediatric Trauma Team and assign clear roles (airway, primary survey, scribe, etc.)
• Prepare paediatric equipment, blood products, and warming devices
PRIMARY SURVEY & RESUSCITATION
<c> Catastrophic External Haemorrhage
• Apply direct pressure, tourniquet, or haemostatic dressings
• Suspect bleeding in "floor + 5 Bs":
o Breast (thorax) o Bone (femur)
o Belly (abdomen) o Brain (scalp/head, esp. infants)
o Buttock (pelvis)
• Apply pelvic binder if instability suspected
• Administer Tranexamic Acid 15 mg/kg IV (max 1g) within 3 hours
A – Airway with Cervical Spine Protection
• Manual in-line stabilisation (MILS) if spinal injury suspected
• Remove foreign bodies, suction secretions
• Use jaw thrust (avoid head tilt)
• Insert oropharyngeal/nasopharyngeal airway if needed
• Prepare for intubation if GCS ≤8 or airway threat
• Avoid spinal boards—use vacuum mattress
B – Breathing
• Assess: Effort, Efficacy, Effects on other systems
• Look: chest rise, flail chest, asymmetry
• Listen: breath sounds, crackles, silence
• Feel: tracheal deviation, crepitus, percussion
• Identify & treat:
1. Tension pneumothorax
2. Open pneumothorax
3. Flail chest
4. Massive haemothorax
5. Aspiration or airway obstruction
• Ventilate if hypoxic, prepare for intubation
C – Circulation with Haemorrhage Control
• Check: HR, pulse volume, cap refill, BP, temperature
• Establish 2 large-bore IV lines or IO access
• Take bloods: crossmatch, gas, lactate, clotting
• If shocked:
o Give 10 mL/kg warmed blood (or crystalloid if unavailable)
o Repeat x1 if ongoing signs of shock
o Activate Massive Haemorrhage Protocol
• Administer:
o Platelets, cryoprecipitate, calcium gluconate
• Apply pelvic binder and splint long bones
• Monitor lactate, Hb, coagulation, electrolytes
D – Disability (Neurological Status)
• Assess AVPU or GCS
• Check pupil size/reactivity
• Suspect raised ICP: GCS <8, posturing, unequal pupils
• Immediate interventions:
o Oxygen @15 L/min
o 20° head elevation
o Controlled ventilation (target ETCO₂ 4.5–5.0 kPa)
o Hypertonic saline or mannitol
o Antipyretics and anticonvulsants if needed
• Prepare for neurosurgical referral and CT brain
• Consider TXA if traumatic brain injury and <3 hrs from injury
E – Exposure & Environmental Control
• Fully expose for hidden injuries (log roll for back)
• Maintain temperature >36°C
• Use warming blankets, warmed IV fluids
• Look for:
o Rashes, bruising, tyre marks
o Penetrating wounds (esp. perineum, axilla, groin)
o Non-accidental injury signs
• Maintain modesty and privacy
SECONDARY SURVEY & EMERGENCY TREATMENT
AMPLE History
• Allergies
• Medications
• Past medical history
• Last meal
• Events/Environment (mechanism, location)
Systematic Head-to-Toe Exam
• Surface: scalp, skin, bruises, abrasions
• Orifices: nose, ears, eyes, mouth, genitals
• Cavities: chest, abdomen, pelvis (inspect and palpate)
• Extremities: pulses, limb deformities, movement
Emergency Interventions
• Insert nasogastric/orogastric tube
• Provide analgesia (after resuscitation)
• Start antibiotics/tetanus prophylaxis for open wounds
• Imaging: CT/trauma series per clinical need
FURTHER STABILISATION & DEFINITIVE CARE
System Reassessments
• Respiration: ABG, ETCO₂, ETT position
• Circulation: ECG, BP (invasive if possible), Hb, lactate
• Neurology: GCS, pupils, ICP if monitored
• Metabolism: Electrolytes, glucose, renal/hepatic function
• Host Defence: Antibiotics, wound care, prevent pressure injury
Monitoring & Transfers
• Continuous reassessment and charting of vital signs
• Urinary catheter if output monitoring needed (1–2 mL/kg/h target)
• Prepare for CT imaging, surgery, or transfer
• Document clearly using trauma proforma
• Consider tertiary survey to detect missed injuries
