Pediatric Trauma Care: A Practical Guide

Preface
Contents
Chapter 1: Introduction: (Unique Factors to Pediatric Trauma)
Introduction
Trauma Organizations
Training Opportunities
Conclusions
References
Chapter 2: Injury Prevention
Conclusions and Take Home Points
References
Chapter 3: Trauma Systems and Pediatric Trauma Centers
History of the Trauma System
Overview of the Trauma System
Prehospital Trauma Care
Interhospital Transfer
Qualifications of a Pediatric Trauma Center
Value of Pediatric Trauma Center Verification
Conclusion
References
Chapter 4: Rural Trauma
Definition
Disparities
Unique Injuries
Mechanisms
Firearm Injuries
Farm Injuries
Anabaptist
All-Terrain Vehicle (ATV)/Utility Terrain Vehicle (UTV)
Lawnmower
Non-accidental Trauma (NAT)
Conclusions and Take Home Points
References
Chapter 5: Disaster Management
Introduction
The Five Phases of Disaster Management
Prevention
Mitigation
Preparedness
Response
Recovery
The Incident Command Structure
Specific Considerations in Mass Casualty Events
Immediate Triage
Transportation
Hospital Based Triage
Real World Example
Conclusion
References
Chapter 6: Paediatric Trauma in Settings of Limited Resource
Introduction
Initial Assessment and Management
Airway and Ventilatory Management
Shock
Thoracic Trauma
Abdominal Injury
Head Trauma
Spine and Spinal Cord Trauma
Musculoskeletal Injuries
Vascular Injury
Thermal Injuries
Caustic Ingestion
Intentional Violence
Conclusion
References
Chapter 7: Initial Trauma Resuscitation
Airway
Breathing
Circulation
Pathophysiology
Access
Resuscitation
Adjunct Treatments
Predictive Scoring for Transfusion
Viscoelastic Monitoring
Disability/Exposure
Conclusions and Take Home Points
References
Chapter 8: Airway Management in Pediatric Trauma
Introduction
Upper Airway Anatomy
Airway Assessment
Airway Management
Surgical Airway
Conclusion/Take Home Points
References
Chapter 9: Shock in the Pediatric Trauma Patient
Conclusions and Take Home Points
References
Chapter 10: Massive Transfusion in the Pediatric Trauma Patient
Epidemiology
Trauma Induced Blood Failure
Crystalloid Versus Blood
Component Therapy, Ratios
Whole Blood
Adjuvants
Tranexamic Acid
Recombinant Factor VIIa
Cryoprecipitate
Prothrombin Complex Concentrate
Thromboelastography (TEG) and Rotational Thromboelastometry (ROTEM)
Delivery
Access
Rapid Transfusers
Storage
Complications
Metabolic Derangements
Transfusion Reactions
Immunological Complications
Hypothermia
How to Guide: Development of a Massive Transfusion Protocol
Barriers to Establishing and Implementing a Massive Transfusion Protocol
Conclusions and Take Home Points
References
Chapter 11: VTE Prophylaxis and Treatment
Introduction
Background and Epidemiology
Complications Associated with VTE
Risk Factors
Methods of Prophylaxis: Mechanical Vs Chemical
Important Considerations
Risk Stratification Tools: Classifying Between High and Low Risk Pediatric Patients (Table 11.1)
Current Pediatric Trauma Society Recommendations
Conclusions
References
Further Reading
Chapter 12: Surgical Nutrition
Narrative
Physiologic Response to Trauma
Nutritional Support
Nutritional Assessment and Development of Feeding Protocol
Estimation of Energy and Protein Needs
Route of Nutritional Support
Enteral Nutrition (EN)
Gastric Vs. Post-pyloric Feeding
Trophic Feedings
Parenteral Nutrition (PN)
Considerations Based Upon Mechanism of Injury
Timing/Initiation of Nutritional Support
Choice of Formula
Formula Supplementation
Monitoring of Nutritional Support
Underfeeding
Refeeding Syndrome [24]
Overfeeding [3]
Challenges to Delivering Adequate Nutrition
Conclusions
References
Further Reading
Chapter 13: Thromboelastography: An Overview
Introduction
Principles
Thromboelastography Assay Types
Clinical Utility
Conclusions and Future Directions
References
Chapter 14: Pediatric Traumatic Brain Injury
Pediatric Traumatic Brain Injury
Epidemiology
Classification of Pediatric TBI
Etiologies and Injury Patterns in Pediatric Traumatic Brain Injury
Initial Evaluation of Pediatric Traumatic Brain Injury
Mild Traumatic Brain Injury
Moderate Traumatic Brain Injury
Severe Traumatic Brain Injury
Clinical Management of the Pediatric TBI Patient
Management of Pediatric Mild TBI
Medical Management of Pediatric Moderate-Severe TBI
Surgical Management of Pediatric Traumatic Brain Injury
Conclusions
References
Chapter 15: Pediatric Facial Trauma
Radiographic/Ancillary Studies
Pediatric Facial Trauma
Skull Fracture
Orbital Roof
Orbital Floor Fractures
Nasal Fractures
Midface
Mandible
Soft Tissue
Facial Nerve
Dog Bite
Burn
Psychosocial Care
Tables
Conclusions
References
Chapter 16: Neck Injuries
Initial Management of the Trauma Patient
Background and Incidence
Clinical Considerations
Larynx
Vascular
Esophagus
Mechanisms of Injury
Blunt Neck Trauma
Laryngotracheal Injury
Vascular Injuries
Esophageal Injuries
Penetrating Neck Trauma
Laryngeal Trauma—Workup and Management
Clinical Presentation
Classic Symptoms
Classic Signs
Flexible Fiberoptic Signs
Imaging
Management of Injuries
Goals
Medical Therapy
Surgical Therapy
Vascular Trauma—Workup and Management
Clinical Presentation
Hard Signs and Symptoms
Soft Signs and Symptoms
Imaging
Management of Injuries
Goals
Medical Therapy
Surgical Therapy
Esophageal Trauma—Workup and Management
Clinical Presentation
Hard Signs and Symptoms
Soft Signs and Symptoms
Imaging
Management of Injuries
Goals
Medical Therapy
Surgical Therapy
Conclusions and Take Home Points
References
Chapter 17: Traumatic Spinal Injuries in Children
Epidemiology
Etiology
Pediatric Spine
Clinical Features
Diagnosis
History & Physical
Imaging Guidelines
Screening Imaging Studies
Initial Management
Fracture Patterns and Radiographic Abnormalities
Atlanto-Occipital Dissociation
Odontoid Fracture
Atlanto-Axial Rotatory Fixation
Subaxial Cervical Spine Injuries
Compression Fractures
Flexion-Distraction Fractures (i.e., Chance Fractures)
Burst Fractures
Vertebral Apophysis Fractures
Slow Vehicle Crush Fractures
Spondylolisthesis/Spondylolysis
Spinous Process or Transverse Process Fractures
C2–C3 Psuedosubluxation
Neurologic Injuries
Anterior Spinal Cord Syndrome
Posterior Spinal Cord Syndrome
Central Spinal Cord Syndrome
Brown-Séquard Syndrome
Cauda Equina Syndrome
Spinal Cord Injury Without Radiographic Abnormality (i.e., SCIWORA)
Special Considerations
Unconscious Patients
Child Abuse
Persistent Pain with Exam and Radiographs
Outcomes
Conclusions and Take Home Points
References
Chapter 18: Thoracic and Chest Wall Injuries
Initial Assessment and Management of the Trauma Patient
Radiographic/Ancillary Studies
Chest Radiograph
Ultrasound
Computed Tomography (CT) Scan
Management of Specific Injuries
Rib Fractures
Management
Flail Chest
Management
Pulmonary Contusion
Management
Pneumothorax
Management
Hemothorax
Management
Retained Hemothorax
Esophageal Injury
Management
Diaphragm Rupture
Management
Conclusions
References
Chapter 19: Penetrating Abdominal Injury
Initial Management of Trauma Patient
Initial Radiographic/Ancillary Studies
Laboratory Studies
Radiographic Studies
Epidemiology
Etiology
Firearm Injury
Cut/Pierce Injury
Injury Patterns
Treatment
Laparotomy
Alternatives to Laparotomy
Emerging Adjuncts
Outcomes
Survival
Morbidity
Conclusions and Take-Home Points
References
Chapter 20: Liver Injury
Initial Management of Trauma Patient
Initial Radiographic/Laboratory Studies
Non-operative Management
Operative Intervention
Complications of Liver Trauma
Discharge and Follow-up
Conclusions and Take Home Points
References
Chapter 21: Pancreas, Duodenum and Biliary Tree
Biliary Tree Injuries
Duodenum
Pancreas
Conclusions
References
Chapter 22: Splenic Trauma
Introduction
Initial Management of Trauma Patient with this Injury
Radiographic/Ancillary Studies
Nonoperative management
Length of Stay
Transfusion Requirement
Associated Injuries
Activity Restriction
Follow-up Imaging Studies
Operative Management
Angioembolization
OPSI/Vaccinations
Guidelines
Conclusions and Take Home Points
References
Chapter 23: Gastric Injury
Initial Assessment
Laboratory and Radiologic Evaluation
Management
Operative Exposure Techniques: [14]
Surgical Management: [1, 14]
Intraoperative Pearls
Post-operative Management and Complications [1, 14]
Conclusions and Take Home Points
References
Chapter 24: Small Intestine and Colon
Initial Management of Trauma Patient
Initial Radiographic/Ancillary Studies
Introduction/Epidemiology
Mechanism
Diagnosis
Physical Exam
Serum Laboratory Considerations
Imaging
Grading Scales
Management
Small Intestine
Colon
Post-operative Care and Outcomes
Conclusion
References
Chapter 25: Rectal Injury
Initial Management of the Trauma Patient
Initial Radiographic/Ancillary Studies
Initial Assessment
Physical Exam
Plain Films
Imaging/Studies
Management
Intraperitoneal Rectal Injury
Extraperitoneal Rectal Injury
Fecal Diversion
Conclusions and Take Home Points
References
Chapter 26: Perineal Injury
Initial Management of the Trauma Patient with Perineal Injury
Initial Radiography/Ancillary Studies
Pediatric Perineal Injury
Epidemiology
Mechanism and Classification of Perineal Injuries
Straddle Injury
Non-straddle Blunt Injury
Penetrating Injury
Sexual/Coital Injury
Radiographic Evaluation
Operative Evaluation
Operative Repair
Conclusions and Take Home Points
References
Chapter 27: Upper Tract Genitourinary Trauma
Renal Trauma
Introduction
Diagnosis
Management
Ureteral Trauma
Introduction
Diagnosis
Management
Conclusion
References
Chapter 28: Lower Tract Genitourinary Trauma
Initial Management of the Trauma Patient
Initial Radiographic/Ancillary Studies
Bladder Trauma
Classification and Diagnosis
Management and Follow-Up
Urethral Trauma
Classification and Diagnosis
Management and Follow Up: Posterior Urethra
Management and Follow-Up: Anterior Urethra
Female Urethral Trauma
Genital Trauma
Male Genital Trauma
Female Genital Trauma
Pediatric Genital Trauma and Abuse
Conclusions and Take Home Points
References
Chapter 29: Pediatric Hip and Pelvis Trauma
Pertinent Anatomy
Mechanism of Injury
Initial Exam
Associated Injuries
Pelvic Ring Injuries
Acetabular Fractures
Hip Dislocation
Reduction Maneuvers
Anterior/Obturator Dislocation
Posterior Dislocation
Proximal Femoral Fractures
Avulsion Fractures
Outcomes
Conclusion and Take Home Points
References
Chapter 30: Pediatric Extremity Injuries
Mechanism of Injury
Initial Exam
Non-Accidental Trauma
Physeal Injury
Upper Extremity Injuries
Elbow
Lower Extremity
Ankle
Conclusion
References
Chapter 31: Injuries to the Hand
Compartment Syndrome of the Hand
Acute Carpal Tunnel Syndrome
High Velocity Injection Injury
Fractures & Dislocations
Open Fractures
Carpal Fractures
Scaphoid Fractures
Metacarpal Fractures.
Metacarpal Shaft Fractures
Metacarpal Neck Fractures (“Boxer’s Fractures”)
Phalangeal Fractures.
Intraarticular Condylar Split Fractures
Phalangeal Neck Fractures
Phalangeal Shaft fractures
Proximal Phalangeal Base fractures
PIP Joint Fracture-Dislocations
Mallet Finger
Jersey Finger
Nailbed Injuries and Amputations
Nailbed Injuries/Tufts Fractures
Seymour fracture
Amputations
Tendon and Neurovascular Injuries
Extensor Tendon Injuries
Flexor Tendon Injuries
Neurovascular Injuries
Miscellaneous
Animal Bites
Bedside Procedure Techniques
Conclusions and Take Home Points
Further Reading
Chapter 32: Vascular Injuries to the Heart and Great Thoracic Vessels
Initial Evaluation and Management
Initial Radiographic/Ancillary Studies
Overview
Cardiac Injuries
Penetrating Cardiac Trauma (Image 32.1)
Blunt Cardiac Trauma (Image 32.2)
Great Vessel Injuries
Penetrating Great Vessel Injuries
Specific Injuries
Blunt Great Vessel Injuries
Specific Injuries
Conclusions
References
Chapter 33: Vascular Injuries of the Abdominal Vessels
Introduction: Initial Management of Trauma Patient: Vascular Injury Consideration
Abdominal Vascular Injury
Aorta
Inferior Vena Cava
Renal
Retroperitoneum
Mesenteric Vessels
Role of Endovascular Therapy
Outcomes
Conclusion
References
Chapter 34: Vascular Injuries of the Extremity
Introduction
Initial Evaluation and Management
Diagnosis
Management
Conclusion
References
Chapter 35: Envenomation, Bites and Stings
Initial Management of Trauma Patient with Envenomation, Bites and Stings
Radiographic/Ancillary Studies
Bites and Stings
Mammal Bites
Human Bites
Dog Bites
Cat Bites
Rabies
Snake Envenomation
Medical Management
Operative Management
Arachnid Bites
Scorpions
Spiders
Conclusions
References
Further Reading
Chapter 36: Child Abuse
Introduction
Epidemiology
Presentation
Sentinel and Escalation Injuries
Screening and Algorithms
History
Physical Exam
Radiographic Findings
Management
Evaluation and Management by Injury Pattern
Bruises
Abusive Head Trauma
Skeletal Injuries
Abdominal Injuries
Burns
Conclusions and Take Home Points
References
Chapter 37: Hypothermia and Near-Drowning
Introduction
Physiology of the Hypothermic and Near-Drowning Victim
Management of the Hypothermic and Near-Drowning Victim
Prevention and Suspicious Injury Patterns
Conclusion
References
Chapter 38: Pediatric Burn Injury
Demographics and Burn Mechanism by Age
Pathophysiology
Classification
Inhalational Injury
Electrical Injury
Chemical Injury
Outpatient and Non-Surgical Burn Management
Wound Cleaning and Debridement
Application of Dressings
Follow-Up
Adjunctive Therapies
Surgical Burn Management
American Burn Association Designated Burn Center Transfer Criteria
Burn Wound Complications
Conclusions and Take Home Points
References
Chapter 39: New Technologies in Pediatric Trauma
Introduction
REBOA for Pediatric Systemic Hemorrhage Control
Direct Site Endovascular Hemorrhage Control and Repair
POCUS of ONSD for ICP Monitoring
Lung POCUS for PARDS
Pulse Co-Oximetry for Management of Solid Organ Injury
Conclusions and Take Home Points
References
Index