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Initial Assessment and Resuscitation of the Trauma Patient 175

ASSESS AIRWAY AND SE-
CURE IT IF NECESSARY +
SUPPLEMENTAL O2.

ASSESS BREATHING AND
TREAT COMPLICATIONS SUCH
AS TENSION PNEUMOTHORAX,
MASSIVE HAEMOTHORAX, etc

ASSESS CIRCULATION AND STOP
ANY EXTERNAL BLEEDING.

GAIN I.V. ACCESS

INTRAOSSEOUS: IN CHILDREN < 6 YR
PERIPHERAL VEIN VENOUS CUTDOWN –
saphenous or cephalic

GIVE IV CRYSTALLOIDS: RL or
NS (0.9%) 20 ml/kg bolus

HAEMODYNAMICALLY UNSTABLE CHILD
INCOMPLETE RESPONSE GOOD RESPONSE – HAEMODY-
NAMICALLY STABLE CHILD

GIVE BLOOD – packed RBCs 10
ml/kg or whole blood 20 ml/kg
ADMINISTER 2nd BOLUS
OF RL or NS 20 ml/kg SECONDARY SURVEY AND DIAG-
NOSTIC INVESTIGATIONS
No
IMPROVED VITAL SIGNS: HR↓, Yes
SBP↑, CR < 2 sec.
COMPLETE
SURGERY OBSERVE
Yes No

SECONDARY SURVEY AND CONTINUE WITH RESUSCITATION
DIAGNOSTIC INVESTIGATIONS.

OBSERVE SURGERY SUGERY

REHABILITATION

Figure 27.2: Algorithm for the initial assessment and resuscitation of a paediatric trauma patient.