General Approach to All Pediatric Patients

Trauma - Pediatric

Basic Life Support

  • Stabilize spine
  • Use modified jaw thrust if airway obstructed
  • Supplemental 100% oxygen
  • Control hemorrhage using direct pressure or pressure dressing
  • Perform head-to-toe survey to identify injuries
  • Splint obvious fractures of long bones
  • Prevent loss of body heat

Advanced Life Support

  • If moderate or severe injuries present, perform Full Pediatric ALS Assessment and Treatment
  • Assess for Pediatric Trauma Triage Criteria and initiate transport to Pediatric Trauma Center if criteria are met
  • Assess for Tension Pneumothorax:
      • Severe respiratory distress with hypoxia
      • Unilateral decreased or absent lung sounds (may see tracheal deviation away from collapsed lung field)
      • Evidence of hemodynamic compromise (shock, hypotension, tachycardia, altered mental status)
    • Pleural decompression for tension pneumothorax should only be preformed when all 3 of the above criteria are present; If indicated Perform Pleural decompression at 2nd intercostal space, mid-clavicular line
  • Initiate transport to an appropriate trauma facility within 10 minutes of arrival on the scene, unless extenuating circumstances (extrication)
  • Perform procedures, history and detailed physical examination en route to the hospital
  • Reassess frequently

Burns

Basic Life Support

  • Remove or cool heat source if present (tar, clothing)
  • Cool compress dressings on minor burns with sterile saline (do not use ice packs)
  • Dry, sterile burn sheet on:
    • 2° burns greater than 15% of Body Surface Area
    • 3° burns
    • Electrical burns
  • Spinal immobilization if high voltage electrical injuries
    • If high voltage electrical injury (> 1000 volts) initiate Trauma Alert
  • If chemical burn, refer to Basic Approach to Hazardous Material Exposures Protocol

Advanced Life Support

  • If moderate or severe pain and no signs of shock (normal cap refill, normal blood pressure for age):
    • Fentanyl (Sublimaze) 0.5 mcg/kg (maximum 25 mcg) slow IV; repeat once after 5 minutes as needed (maximum 50 mcg total dose) OR 1.5 mcg/kg (max 100 mcg) intranasal via MAD (divide dose equally between nostrils)
      • Preferentially use intranasal delivery via MAD for those where IV access may be difficult to obtain in a timely fashion
      • Use with caution if inhalational injury or respiratory symptoms
  • Expedite transport to nearest Trauma Center if Trauma Red or Trauma Alert

Pediatric Trauma Alert Criteria