Version May 2024
| Assessment | Management |
| 0 up to 5 minutes | |
| Mobilize trauma resources | Immobilize cervical spine |
| Assess vital signs | |
| Airway – Identify: | |
| Obstruction | Open airway; suction secretions |
| Administer 100% O2 | |
| Midface fracture/difficult airway or Direct airway injury | Surgical airway |
| Breathing – Identify: | |
| Tension pneumothorax | Needle decompression; place chest tube or pigtail catheter |
| Massive hemothorax | Place chest tube |
| Open pneumothorax | Apply 3-sided occlusive dressing |
| Flail chest | Perform bag-valve-mask ventilation |
| Impaired oxygenation/ventilation | Rapid sequence endotracheal intubation |
| Circulation – Identify: | |
| Absent circulation | Cardiac compressions, thoracotomy if witnessed arrest |
| External hemorrhage | Control external hemorrhage |
| Signs of shock | Secure IV access; obtain laboratory studies |
| Fluid resuscitation* | |
| Cardiac tamponade | Pericardiocentesis followed by thoracotomy |
| Pelvic fracture | Wrap or bind pelvis |
| Disability – Identify: | |
| Level of consciousness (GCS) | Endotracheal intubation for rapidly declining GCS, GCS ≤8 or herniation¶ |
| Pupillary response | Elevate head of bed to 30° if no signs of shock |
| Signs of spinal cord injury | |
| Signs of impending herniation | Moderate hyperventilation (pCO2 30 to 35) |
| Neurosurgical consultation | |
| Administer osmotic agents if normotensive | |
| Exposure – Identify: | |
| Hypothermia | Remove clothing |
| Initiate rewarming | |
| 5 up to 15 minutes | |
| Repeat vital signs every 5 minutes | Continue care of airway, breathing, circulation, and disability |
| Reassess response to interventions | Proceed to intraosseous or central venous access if peripheral IV access unsuccessful |
| Intubated patients: | |
| Monitor end-tidal CO2 | Gastric tube placement |
| Obtain blood gas | Perform thoracotomy in patients who lose vital signs during resuscitation |
| Persistently hypotensive patients: | |
| FAST examination, if available | |
| 15 up to 20 minutes | |
| Reassess response to interventions | Continue care of airway, breathing, circulation, and disability |
| Reassess level of consciousness | Logroll patient and remove spine board |
| Examine head, neck, chest, abdomen, pelvis, and extremities | Provide analgesia |
| Place urinary catheter if no signs of urethral disruption | |
| Obtain screening radiographs, as indicated | Operative management for patients who remain hemodynamically unstable despite rapid blood infusion per trauma surgeon |
| 20 up to 60 minutes | |
| Reassess response to interventions | Provide analgesia |
| Splint fractures | |
| Reassess level of consciousness | Update tetanus immunization, as needed |
| Perform complete PE (secondary survey) | Antibiotics for open fracture, contaminated wounds, or suspected bowel perforation |
| Repeat selected laboratory studies (eg, hematocrit, blood gas, glucose) | Determine need for emergency life- or limb-saving operative procedures |
| CT of head, neck, chest, abdomen, or pelvis, as indicated by clinical findings | Transition to definitive care at a regional pediatric trauma center |
O2: oxygen; CO2: carbon dioxide; GCS: Glasgow coma scale; pCO2: partial pressure of carbon dioxide; IV: intravenous; FAST: focused abdominal sonography for trauma; PE: physical examination; CT: computed tomography.
* Administer 20 mL/kg of warmed normal saline or Ringer's lactate as rapidly as possible using a rapid infuser or the push/pull method via stopcock. In children with severe head injury, the aim is to ensure normal, but not excessive, circulating volume.
¶ Signs of herniation include coma, unilateral pupillary dilation with outward eye deviation followed by hemiplegia, hyperventilation, Cheyne-Stokes respirations, and/or decerebrate or decorticate posturing. Refer to UpToDate topics on severe traumatic brain injury in children for more specific guidance.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
