Trauma - initial management in PICU
Date last published:
Trauma is the leading cause of mortality in children>6 months
This document is only valid for the day on which it is accessed. Please read our .
Paediatric intensive care
General points
Trauma is the leading cause of mortality in children>6 months
Ask about mechanism of injury including height of fall (>3m), GCS at scene, protective restraints and resuscitation required.
Falls, MVA, pedestrian injury and drowning are most common
Head injuries are likely due to weak neck control, relatively large head and increased risk of being thrown.
Most abdominal trauma is treated conservatively
A rapid, co-ordinated multidisciplinary approach is required.
Investigations
| Bloods | FBC / electrolytes / amylase/ liver function tests / urgent crossmatch |
| XR | C Spine/ Chest / Pelvis |
| CT | C Spine if unconscious, chest, abdo if indicated |
Management
Primary survey
| Airway |
| 100% 02 in all cases Jaw thrust (no head tilt) if obstructed upper airway Suction to remove foreign bodies Oropharyngeal airway Intubate if GCS<8 or rapidly fluctuating LOC upper airway obstruction/ major facial trauma chest trauma, inhalational burn need for prolonged/ controlled ventilation (head injury) Intubation: preoxygenate, inline stabilisation, oral ETT, fluid anaesthetic gas induction if airway obstruction Surgical Airway if unable to intubate |
| Breathing |
| Ventilate to normal pO2 and pCO2. |
| Circulation |
| Two large cannulae (intraosseous if necessary) Saline/ colloid bolus 20/kg and repeat as necessary. Transfuse if blood loss or high fluid requirement (O neg if urgent) Titrate to heart rate, urine output |
| Drugs and Disability |
| Determine pupil size, reactivity and conscious state:GCS, AVPU Morphine: titrate to pain: 0.05-0.1 mg/kg |
| Exposure |
| Maintain normothermia |
Secondary survey
Expose patient, comprehensive regional review all body parts
Glasgow Coma Scale (GCS)
| Glasgow Coma Scale | ||
| Eye opening | Motor response | Verbal response |
| 4 spontaneous | 6 obeys commands | 5 orientated |
| 3 to voice | 5 localises to pain | 4 confused |
| 2 to pain | 4 flexion withdrawal | 3 inappropriate |
| 1 no response | 3 abnormal flexion | 2 incomprehensible |
| 2 extension | 1 no response | |
| 1 no response | ||
AVPU
| AVPU (for children under 2 years old) | |
| Alert | |
| Responds to Voice | |
| Responds to Pain | purposeful - localises non-purposeful - withdrawal, abnormal flexion or extension |
| Unresponsive | |