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178 Initial Assessment and Resuscitation of the Trauma Patient
Table 27.2: Evidence-based research. Table 27.3: Evidence-based research.
The efficacy of computed tomography in evaluating
Title Pediatric trauma—the care of Anthony Title
abdominal injuries in children with major head trauma
Authors Lawton L Authors Beaver BL, Colombani PM, Fal A, et al
Accident and Emergency, The Radcliffe Hospital, Department of Pediatric Surgery and Radiology, The Johns
Institution
Headington, Oxford, UK Institution Hopkins University School of Medicine, Baltimore, Maryland,
USA
Reference Accident Emerg Nurs 1995; 3:172–176
Reference J Pediatr Surg 1987; 22(12):1117–1122.
Problem The care of a paediatric trauma patient.
The efficacy of combined computed tomography of the head
The adaption of the ABCs of trauma care for a paediatric Problem and abdomen in evaluating abdominal injury in a child with
Intervention patient, taking into consideration the differences between major head trauma and unreliable physical examination.
adults and children.
Combined head and abdominal CT scans were performed
Comparison/ This is a practical example of how a 5-year-old child, Intervention on children with serious closed head trauma (GCS ≤ 10)
control who was involved in a road traffic injury, was managed and suspected abdominal injury at the same time.
(quality of holistically. The primary survey of the child and resuscitation Comparison/
started immediately when he was brought into the Accident
edvidence) and Emergency unit. control Of 65 children with GCS ≤ 10, 23% were found to have
(quality of significant intraabdominal injury, but only two required
This study reinforces the point that paediatric trauma edvidence) laparotomy.
care follows the same principles as for adult trauma with
Outcome/ important differences such as the child’s physiology,
anatomy, and psychological needs, which should be
effect taken into consideration if the child with trauma/injury is to Outcome/ All patients survived.
effect
survive. The trauma child should never be considered as a
“little adult”. The significance of the study is that, based on the fact that
nonoperative treatment of injuries to the spleen, liver, etc.
This study reinforces the point that paediatric trauma Historical have been carried out successfully, there is a need to find
Historical care follows the same principles as for adult trauma with significance/ noninvasive methods of evaluating patients with suspected
important differences such as the child’s physiology, anatomy,
significance/ and psychological needs, which should be taken into comments abdominal injury and concomitant severe head trauma
comments consideration if the child with trauma/injury is to survive. The without resorting to DPL. With this method, they avoided
trauma child should never be considered as a “little adult”. surgery in 13 children.

Key Summary Points
1. Start the management of the injured child with a primary 5. Do not hesitate to consult other subspecialties, such as the
survey (ABCDEF), which involves assessment, stabilisation, neurosurgeon, urologist, trauma surgeon, and so forth.
and management of all acute life-threatening conditions.
6. Do the minimum radiologic and laboratory investigations
2. The primary assessment and resuscitation are performed necessary during the primary survey period. The rest can
simultaneously, which means there should be a paediatric be done when the child is haemodynamically stable and a
trauma team in readiness for such an eventuality. There is secondary survey has been performed to determine the need
always a leader of such a team who organises the members of for more extensive investigations.
the team to execute various functions. 7. Do not hesitate to carry out a laparotomy (for damage control)
3. It is necessary to reassess the injured child frequently with if all efforts at resuscitating the child are not yielding the
normal parameters of the child’s age group in mind so as to desired results, the patient’s condition remains unstable, and
take the appropriate action should these change for the worse. an intraabdominal catastrophe is suspected.
The proper sequence to bear in mind is: assessment of injured 8. Transfer only haemodynamically stable but severely injured
child, interventions and reassessment after each intervention. children to the next competent facility. It is good practice to try
4. Always keep the cervical spine immobilised until a neck injury to stabilise the injured child before transfer.
is excluded.

References

1. Arensman RM, Madonna MB. Initial management and stabilization 5. Schvartsman C, Carrera R, Abramovici S. Initial assessment and
of pediatric trauma patients. The Child’s Doctor. J Children’s transportation of an injured child. J Pediatr (Rio J) 2005; 81(5
Memorial Hospital, Chicago. Available at http://www.childsdoc.org/ Suppl):S223–S229.
fall97/trauma/trauma.asp (accessed 17 November 2008).
6. Alterman DM. Considerations in pediatric trauma. Available at
2. Shafi S, Kauder DR. Fluid resuscitation and blood replacement http://www.emedicine.com/med/TOPIC3223.HTM (accessed 5
in patients with polytrauma. Clin Orthopaed Related Res 2004; October 2008).
422:37–42.
7. Zaritsky AL, Nadkarni VM, Hickey RW, et al., eds. Pediatric
3. Vella AE, Wang VJ, McElderry C. Predictors of fluid resuscitation in Advanced Life Support Provider Manual. American Heart
pediatric trauma patients. J Emerg Med 2006; 31(2):151–155. Association, 2002.
4. Lawton L. Paediatric trauma—the care of Anthony. Accident Emerg 8. American College of Surgeons. Advanced Trauma Life Support
Nurs 1995; 3:172–176. Course for Physicians. Student Manual, 1993.