- Trauma is the commonest cause of death in childhood
- Road traffic accidents and falls account for 80% of injuries
- Thoracic and abdominal injuries usually result from blunt trauma
- Penetrating injuries are uncommon
- Significant injuries can occur without overlying fractures
Assessment
- Assessment should follow same principles as adult
- Important to know weight of child to calculate fluid volumes and drug doses
- Weight can be estimated from age or head-to-toe length
Airway and breathing
- Airway management in a child can be difficult due to
- Large head relative to size of body
- Small oral cavity with large tongue
- Large angle of the jaw
- Larynx is cephalad
- Trachea is short
- Infants less than 6 months are obligate nose breathers
- Uncuffed endotracheal tubes should be used in children before puberty
Circulation
- Normal values for pulse and blood pressure vary with age
- Less than one year, pulse = 120 to 140 and systolic BP is 70-90 mmHg
- Between 2 and 5 years, pulse is 100-120 and systolic BP is 80-90 mmHg
- Between 5 and 12 years, pulse is 80-100 and systolic BP is 90-110 mmHg
- Venous access in a child can be difficult
- Femoral or external jugular access may be required
- If percutaneous cannulation fails need to consider
- Medial cephalic venous cut down
- Long saphenous venous cut down
- Intraosseous infusion
- Initial resuscitation should be with a 20 ml/kg crystalloid bolus
Occult chest injuries in children
- Pulmonary contusion
- Pulmonary laceration
- Intrapulmonary haemorrhage
- Tracheobronchial tear
- Myocardial contusion
- Diaphragmatic rupture
- Partial aortic or other great vessel disruption
- Oesophageal tears
Burns
- Relative %BSA of different regions varies between children and adults
| Region |
Adult (%) |
Child (%) |
| Head |
9 |
19 |
| Body |
18 |
18 |
| Upper limb |
9 |
9 |
| Lower limb |
18 |
13 |
| Perineum |
1 |
1 |
Diagnostic criteria for non-accidental injury
- Delay in seeking medical advice
- Vague or inconsistent account of the accident
- Discrepancy between the history and degree of injury
- Abnormal parental behaviour or lack of concern for the child
- Interaction between child and parents is abnormal
- Finger tip bruising over upper arm, trunk, face or neck
- Bizarre injuries - bites, cigarette burns or rope marks
- Sharply demarked burns in unusual site
- Perioral injuries - torn frenulum
- Retinal haemorrhages
- Ruptured internal organs without a history of major trauma
- Perianal or genital injury
- Long bone fractures in children less than 3 years
- Injuries of differing ages
Bibliography
Duncan A W. Radiological features of non-accidental injury. Hosp Med 1999; 60:
794-799.
Dykes E H. Paediatric trauma. Br J Anaesth 1999; 83: 130-138.
Rance C H, Singh S J, Kimble R. Blunt abdominal trauma in children. J Paediatr Child
Health 2000; 36: 2-6.
Scherer L R. Critical care of the severely injured child. Surg Clin North Am 2002;
82: 333-347.
Wetzel R C. Burns R C. Multiple trauma in children: critical care overview. Crit
Care Med 2002; 30 (Suppl 11); S468-477. |