Trauma Pediatric - part 2 pot

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Committee on Assuring the Health of the Public in the 21st Century, Institute of Medicine, National Academy of Sciences. The Future of the Public’s Health in the 21st Century. Washington: National Academy Press, 1988. 30b. www.injuryfree.org. 31. Davidson LL, Durkin MS, Kuhn L, et al. The impact of the safe kids/health neighbor- hoods injury prevention program in Harlem 1988 to 1991. Am J Public Health 1994; 84:580–596, 1992. 32. Laraque D, Barlow B, Davidson L, et al. Central Harlem playground injury project: a model for change. Am J Public Health 1994; 84:1691–1692. 33. Laraque D, Barlow B, Durkin M, et al. Injury prevention in an urban setting: challenges and successes. Bull NY Acad Med 1995; 72:16–30. 34. Durkin M, Kuhn L, Davidson L, et al. Epidemiology and prevention of severe assault and gun injuries to children in an urban community. J Trauma 1996; 41: 667–673. 35. Durkin M, Olsen S, Barlow B, et al. The epidemiology of urban pediatric neurological trauma: evaluation of, and implications for, injury prevention programs. Neurosurgery 1998; 42:300–310. 36. Durkin M, Laraque D, Lubman I, et al. Epidemiology and prevention of traffic injuries to urban children and adolescents. Pediatrics 1999; 103:e74. 37. Pollack MM, Alexander SR, Clarke N, et al. Improved outcomes from tertiary center pediatric intensive care: a statewide comparison of tertiary and nontertiary care facilities. Crit Care Med 1991; 19:150–159. 38. Nakayama DK, Copes WS, Sacco WJ. Differences in pediatric trauma care among pediatric and nonpediatric centers. J Pediatr Surg 1992; 27:427–431. 39. Hall JR, Reyes HM, Meller JL, et al. Traumatic death in urban children, revisited. Am J Dis Child 1993; 147: 102–107. 40. Cooper A, Barlow B, DiScala C, et al. Efficacy of pediatric trauma care: results of a population-based study. J Pediatr Surg 1993; 28:299–305. 41. Hall JR, Reyes HM, Meller JT, et al. Outcome for blunt trauma is best at a pediatric trauma center. J Pediatr Surg 1996; 31:72–77. 42. Hulka F, Mullins RJ, Mann NC, et al. Influence of a statewide trauma system on pediatric hospitalization and outcome. J Trauma 1997; 42:514–519. 43. Hulka F. Pediatric trauma systems: critical distinctions. J Trauma 1999; 47:S85–S87. 44. Potoka DA, Schall LC, Gardner MJ, et al. Impact of pediatric trauma centers on mortality in a statewide system. J Trauma 2000; 49:237–245. 45. Potoka DA, Schall LC, Ford HR. Improved functional outcome for severely injured children treated at pediatric trauma centers. J Trauma 2001; 51:824–834. 46. Osler TM, Vane DW, Tepas JJ, et al. Do pediatric trauma centers have better survival rates than adult trauma centers? An examination of the National Pediatric Trauma Registry. J Trauma 2001; 50:96–101. 47. Farrell LS, Hannan EL, Cooper A. Severity of injury and mortality associated with pediatric blunt injuries: hospitals with pediatric intensive care units vs. other hospitals. Pediatr Crit Care Med. In press. 48. Knudson MM, Shagoury C, Lewis FR. Can adult trauma surgeons care for injured children? J Trauma 1992; 32:729–739. 49. Fortune JM, Sanchez J, Graca L, et al. A pediatric trauma center without a pediatric surgeon: a four-year outcome analysis. J Trauma 1992; 33:130–139. 50. Rhodes M, Smith S, Boorse D. Pediatric trauma patients in an ‘‘adult’’ trauma center. J Trauma 1993; 35:384–393. 51. Bensard DD, McIntyre RC, Moore EE, et al. A critical analysis of acutely injured children managed in an adult level I trauma center. J Pediatr Surg 1994; 29:11–18. 52. D’Amelio LF, Hammond JS, Thomasseau J, et al. ‘‘Adult’’ trauma surgeons with pediatric commitment: a logical solution to the pediatric trauma manpower problem. Am Surg 1995; 61:968–974. Organizing the Community for Pediatric Trauma 29 53. Partrick DA, Moore EE, Bensard DD, et al. Operative management of injured children at an adult level I trauma center. J Trauma 2000; 48:894–901. 54. Sherman HF, Landry VL, Jones LM. Should level I trauma centers be rated NC-17? J Trauma 2001; 50:784–791. 55. American College of Surgeons Committee on Trauma. Consultation for Trauma Systems. Chicago: American College of Surgeons, 1996. 56. Su E, Mann NC, McCall M, et al. Use of resuscitation skills by paramedics caring for critically injured children in Oregon. Prehosp Emerg Care 1997; 1:123–127. 57. Paul TR, Marias M, Pons PT, et al. Adult versus pediatric prehospital trauma care: is there a difference? J Trauma 1999; 47:455–459. 58. Gausche M, Lewis RJ, Stratton SJ, et al. Effect of out-of-hospital pediatric endotracheal intubation on survival and neurological outcome: a controlled clinical trial. JAMA 2000; 283:783–790. 59. Cooper A, DiScala C, Foltin G, et al. Prehospital endotracheal intubation for severe head injury in children: a reappraisal. Sem Pediatr Surg 2001; 10:3–6. 60. Cooper A, Barlow B, DiScala C, et al. Efficacy of MAST use in children who present in hypotensive shock. J Trauma 1992; 33:151. 61. Cooper A, Barlow B, DiScala C, et al. Efficacy of pre-hospital volume resuscitation in children who present in hypotensive shock. J Trauma 1993; 35:160. 62. Cooper A, Barlow B, DiScala C, et al. Efficacy of intraosseous infusions in infants and young children who present in hypotensive shock following major trauma. Presented at the Annual Meeting of the Surgical Section of the American Academy of Pediatrics, Washington, DC, October 1993. 63. Teach SJ, Antosia RE, Lund DP, et al. Prehospital fluid therapy in pediatric trauma patients. Pediatr Emerg Care 1995; 11:5–8. 64. Herzenberg JE, Hensinger RN, Dedrick DK, et al. Emergency transport and positioning of young children who have an injury of the cervical spine. J Bone Joint Surg 1989; 71-A:15–22. 65. Schafermeyer RW, Ribbeck BM, Gaskins J, et al. Respiratory effects of spinal immobilization in children. Ann Emerg Med 1991; 20:1017–1019. 66. Nypaver M, Treolar D. Neutral spine positioning in children. Ann Emerg Med 1994; 23:208–211. 67. Curran C, Dietrich AM, Bowman MJ, et al. Pediatric cervical-spine immobilization: achieving neutral position? J Trauma 1995; 39:729–732. 68. Jaffe DM, Binns H, Radkowski MA, et al. Developing a clinical algorithm for early management of cervical spine injury in child trauma victims. Ann Emerg Med 1987; 16:270–276. 69. Rachesky I, Boyce WT, Duncan B, et al. Clinical prediction of cervical spine injuries in children: radiographic abnormalities. AJDC 1987; 141:199–201. 70. Hoffman JR, Mower WR, Wolfson AB, et al. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. N Engl J Med 2000; 343:94–99. 71. Viccellio P, Simon H, Pressman BD, et al. A prospective multicenter study of cervical spine injury in children. Pediatrics 2001; 108:e20. 72. Pang D, Pollack IF. Spinal cord injury without radiographic abnormality in children— the SCIWORA syndrome. J Trauma 1989; 29:654–664. 73. Frost M, Huffer WE, Sze CI, et al. Cervical spine abnormalities in Down syndrome. Clin Neuropath 1999; 18:250–259. 74. Tepas JJ, Mollitt DL, Talbert JL, et al. The pediatric trauma score as a predictor of injury severity in the injured child. J Pediatr Surg 1987; 22:14–18. 75. Kaufmann CR, Maier RM, Rivara FP, et al. Evaluation of the pediatric trauma score. JAMA 1990; 263:69–72. 76. Jubelirer RA, Agarwal NN, Beyer FC, et al. Pediatric trauma triage: review of 1,307 cases. J Trauma 1990; 30:1544–1547. 30 Cooper 77. Phillips S, Rond PC, Kelly SM, et al. The need for pediatric-specific triage criteria: results from the Florida Trauma Triage Study. Pediatr Emerg Care 1996; 12: 394–399. 78. Hannan E, Farrell L, Meaker P, et al. Predicting inpatient mortality for pediatric blunt trauma patients: a better alternative. J Pediatr Surg 2000; 35:155–159. 79. Engum SA, Mitchell MK, Scherer LR, et al. Prehospital triage in the injured pediatric patient. J Pediatr Surg 2000; 35:82–87. 80. Sola JE, Scherer LR, Haller JA, et al. Criteria for safe cost-effective trauma triage: prehospital evaluation and distribution of injured children. J Pediatr Surg 1994; 29: 738–741. 81. Moront ML, Gotschall CS, Eichelberger MR. Helicopter transport of injured children: system effectiveness and triage criteria. J Pediatr Surg 1996; 31:1183–1188. 82. Kotch SJ, Burgess BE. Helicopter transport of pediatric versus adult trauma patients. Prehosp Emerg Care 2002; 6:306–308. 83. Foltin G, Salomon M, Tunik M, et al. Developing pediatric pre-hospital advanced life support: the New York City experience. Pediatr Emerg Care 1990; 6:141–144. 84. National Highway Traffic Safety Administration. National Standard Curriculum for First Responders. Washington: National Highway Traffic Safety Administration, 1995. 85. National Highway Traffic Safety Administration. National Standard Curriculum for Emergency Medical Technician-Basics. Washington: National Highway Traffic Safety Administration, 1994. 86. National Highway Traffic Safety Administration. National Standard Curriculum for Emergency Medical Technician-Paramedics. Washington: National Highway Traffic Safety Administration, 1998. 87. National Highway Traffic Safety Administration. EMS Education Agenda for the Future. Washington: National Highway Traffic Safety Administration, 2001. 88. Prehospital Trauma Life Support Committee, National Association of Emergency Medical Technicians, in cooperation with the Committee on Trauma, American College of Surgeons, McSwain NE, Frame S, Salomone JP, eds. PHTLS: Basic and Advanced Prehospital Trauma Life Support, 5th ed. St Louis: Mosby, 2003. 89. Dieckmann R, Brownstein D, Gausche M, eds. Pediatric Emergencies for Prehospital Professionals (PEPP) Student Manual. Elk Grove Village and Sudbury: American Academy of Pediatrics and Jones and Bartlett Publishers, 2000. 90. Markenson DS. Pediatric Prehospital Care. Upper Saddle River: Prentice Hall, 2002. 91. Luten RC, Seidel JS, Lubitz DS, et al. A rapid method for estimating resuscitation drug doses from length in the pediatric age group. Ann Emerg Med 1988; 17:576–581. 92. Kanter RK, Boeing NM, Hannan WP, et al. Excess morbidity associated with interhospital transport. Pediatrics 1992; 90:893–898. 93. Edge WE, Kanter RK, Weigle CGM, et al. Reduction of morbidity in interhospital transport by specialized pediatric staff. Crit Care Med 1994; 22:1186–1191. 94. Smith DF, Hackel A. Selection criteria for pediatric critical care transport teams. Crit Care Med 1983; 11:10–12. 95. MacNab AJ. Optimal escort for interhospital transport of pediatric emergencies. J Trauma 1991; 31:205–209. 96. American Academy of Pediatrics Committee on Hospital Care. Guidelines for air and ground transport of pediatric patients. Pediatrics 1996; 78:943–950. 97. Day S, McCloskey K, Orr R, et al. Pediatric interhospital critical care transport: con- sensus of a national leadership conference. Pediatrics 1991; 88:696–704. 98. Kahn CA, Pirrallo RG, Kuhn EM. Characteristics of fatal ambulance crashes in the United States: an 11-year retrospective. Pre-hosp Emerg Care 2001; 5:261–269. 99. Levick NR, Winston F, Aitken S, et al. Application of a dynamic testing procedure for ambulance pediatric restraint systems. Soc Automotive Eng Australasia 1998; 58:45–51. Organizing the Community for Pediatric Trauma 31 100. Levick NR, Li G, Yannaccone J. Biomechanics of the patient compartment of ambulance vehicles under crash conditions: testing countermeasures to mitigate injury. Soc Automotive Eng Australasia 2001; 2001:1–73. 101. National Highway Traffic Safety Administration/Emergency Medical Services for Children/Health Resources and Services Administration. Do’s and Don’ts of Trans- porting Children in an Ambulance: Fact Sheet. Washington: National Highway Traffic Safety Administration/Emergency Medical Services for Children/Health Resources and Services Administration, 1999. 32 Cooper 3 Organizing the Hospital for Pediatric Trauma Care Max L. Ramenofsky Geisinger Medical Center, Danville, Pennsylvania, U.S.A. HISTORY OF TRAUMA CENTERS The development of trauma centers in the United States has a varied background, which takes its origins from many of the wars this country has fought. Many aspects, which are now considered to be integral parts of any trauma center, originated on the battlefield. Aspects such as immediate availability of surgeons who can provide immediate surgical care to trauma victims, facilities capable of providing any indicated treatment (Mobile Army Surgical Hospital units), pre-hospital personnel to identify and stabilize the victim in the field and transport the patient to an emergency room capable of providing the indicated therapy, transport systems such as ground a mbulances and helicopters to transport the victims, just to mention a few. All of these components originated in the U.S. military. The civilian trauma system originated in the State of Illinois in 1967 with the inception of the first ‘‘adult’’ trauma center at Cook County Hospital under the leadership of Drs. Robert Freeark and Robert Baker. Shortly after this, Dr. R. Adams Cowley initiated the ‘‘Shock Trauma’’ Unit (Maryland Institure for Emergency Medical Services System) at the University of Maryland in Baltimore. Following closely on the heels of the first two ‘‘adult’’ trauma centers, the U.S. Congress passed a number of ‘‘emergency medical services systems acts,’’ which defined many aspects of the things needed by a trauma system in the prehospital arena. These included the makeup of ambulances (equipment), the necessity for com- munications systems, which would allow pre-hospital personnel to speak with either an individual distant from or in a trauma receiving facility, and the training necessary for personnel in an ambulance unit, i.e., emergency medical technicians (EMTs), paramedics, etc. It is an interesting sidelight to note that prior to the passage of the various emergency medical services systems acts, many ambulance drivers were, in fact, funeral home directors. 33 PEDIATRIC TRAUMA CENTERS It is of interest to note that in 1962 the first Pediatric Trauma Center was established by Dr. Peter Kottmeier at the Kings County Hospital, in Brooklyn, New York, five years before the first adult trauma center opened its doors. Trauma care was further advanced in the United States by the American College of Surgeons (ACS), which in the early 1920s started the Committee on Trauma (COT). The purpose of the COT was to improve the care of the trauma victim by education. In February of 1984, the COT developed the first resources or standards manual, which defined the standards of care necessary to treat trauma patients (1). These standards were primarily focused on the hospital resources necessary for this task. Not including the 1984 pamphlet, there have been four editions of this manual, the most current being entitled, Resources for the Optimum Care of the Injured Patient (2–5). The next edition is tentatively scheduled for publication in 2005. The ACS COT established the Verification Subcommittee in February of 1987. This subcommittee’s purpose was to verify compliance by hospitals wishing to become ACS-verified trauma centers, with the standards of care promulga ted by the resources manual. The first document describing the resources necessary to treat the injured child was published in the Journal of Trauma in 1982 (6). The COT first included an appendix on Pediatric Trauma Care in their original 1984 pamphlet, Appendix J (1). The first pediatric chapter in the ACS resource manual appeared in the 1987 edition (3). The COT has defined what is meant by the term ‘‘pediatric trauma center’’ by dividing trauma centers into levels. The highest level is a Level-I Pediatric Trauma Center locat ed in a children’s hospital. A similar designation and quality of care may be present in a Level-I Adult Trauma Center with pediatric expertise. Children’s hospitals can also apply to become a Level-II Pediatric Trauma Center. By ACS standards, all trauma centers, regardless of their designation level, must have the ability to stabilize and transfer injured children when received in their institution. PREPLANNING Before the first patient is seen and treated in any institution that desires to become a trauma cen ter or have a trauma unit, there is a great deal of organization that must be accomplished. The decision to apply for such a designation is the first priority. This decision is not one that can be made by a single individual or department. The decision is one that must be embraced by the entire institution for the simple reason that trauma, by its very nature, is extremely disruptive to any hospital’s schedule. Trauma is a disease that can and does occur at any and all times. The orderly carrying out of a busy operating room schedule can be disrupted because of the necessity of bringing an injured patient to the operati ng room at any time. Other resources such as laboratory and radiology are similarly disrupted due to the need for immediate results from the laboratory as well as immediate access to a computerized tomography scanner, mag- netic resonance imaging, and/or interventional radiological procedures. The requirement for a designated and immediately available trauma team is similarly disruptive. Thus, it should be apparent that the decision to seek designation as a trauma center is one that requires agreement of many, if not all, departments within a busy hospital. The hospital’s administration must agree and support this decision. 34 Ramenofsky Commitment The single most important component for any institution seeking a trauma designation is commitment. Commitment to provide the personnel, equipment, space, an d all other resources necessary for treatment of the injured patient, 24 hours a day, seven days a week. Facilities The injured patient generally enters an institution through its emergency department (ED). Often the ED is very busy and crowded. An injured patient should not be expected to wait until a room opens before being seen. Thus a ‘‘trauma room’’ or resuscitation bay must always be available. This is an expense for the institution, but assessment and resuscitation must be available without delay. The makeup of such a room should include appropriate IV fluids, catheters, surgical instrument sets, warming equipment, including a method to rapidly warm the entire room, medications and enough space for an entire team of physicians, nurses, and technicians to have easy access to the patient. Often a hospital that constructs a new trauma room will include a ceiling-mounted X-ray unit in the room. If not, there must be sufficient space for a portable X-ray machine to be wheeled into the space. For any institution that treats injured children, the Broselow System is a reasonable method of organizing the trauma room. This system provides color- coded equipment such as airways, laryngoscopes, endotracheal tubes, suction catheters, vascular access devices, nasogastric (NG) tubes, urinary cathet ers, and chest tubes. The co lor-coding is based on the child’s weight. In addition, the Broselow tape is a clever method of rapidly determining the child’s weight based on height and can be used in the trauma room for quick determination of weight, IV-fluid bolus infusion amounts, and emergency medications. The Broselow tape can be mounted in a Lucite holder and kept permanently in the room. When so mounted it measures roughly five feet in length and does not have a tendency to be lost. The facilities necessary for an institution to become a trauma center are not limited to the emergency room. The institution must have immediate availability to CT scanning, angiography, interventional radiology, operating rooms, intensive care units, and patie nt floors. Another requirement is the availability of rehabilita- tion medicine. Radiology In addition to routine radiographic procedures such as chest, abdominal, extremity, and spine X rays, the institution must provide immediate access to CT scanning for the injured child. The CT scan is the major diagnostic modality utilized in both children and adults, and must always be available to the trauma patient. Operating Room An operating room must always be available for the trauma patient. In a busy hospital this is difficult because this requirement decreases by one the number of rooms available for routine elective surgery. In addition to having an OR immediately available, personnel, including nurses, technicians, and anesthesiolo- gists, must be immediately available 24/7. Organizing the Hospital for Pediatric Trauma Care 35 Pediatric Intensive Care Intensive care must be available for the injured child, preferably in a pediatric intensive care unit (PICU) with appropriately trained and trauma credentialed nurses. Should a PICU not be present, an intensive care unit may meet this requirement with appropriately trained and credentialed pediatric nurses. The equipment necessary for PICU care is well documented in the ACS resources manual. Patient Floors There must be beds available on a pediatric floor for patients being admitted to the hospital with injuries. Nursing care must be adequate in this area as well. Personnel The hospital personnel required for an institution to become a pediatric trauma center includes various physician specialties, pediatric-trained nurses working in certain specialized areas of the hospital, laboratory technicians, radiological technicians, and social workers. This is not a comprehensive list but is the basic catalogue of players. Physicians The group of physicians immediately responsible for the care of an injured child is made up of the surgical specialties. Pediatric general surgery includes within its training the care of the injured child. The pediatric surgical team must include a leader of that team whose responsibility it is to organize the team. In the ED, this trauma team is expected to meet the patient on arrival. Once the patient has been placed in the resuscitation room, the team begins its work. Hopefully, the ED has been notified by the pre-hospital personnel of the cause of the injury, e.g., motor vehicle crash, gunshot wound, stab wound , fall, and is prepared to start the resuscitation phase. Occurring simultaneously with the resuscitation phase is the diagnostic phase. How- ever, the team should be trained to the important fact that the diagnosis is less important than saving the life of the injured child. Thus, the team should be aware that the lack of a diagnosis should never impede the application of an indicated treatment. For example, if the patient cannot maintain their airway, the airway should be secured before the diagnosis of the cause of the unstable airway is deter- mined. To reverse the process, and first determine the cause of the unstable airway before treating, may result in the death of the patient. The composition of the team, in addition to the leader, is generally two other surgeons, an anesthesiologist or emergency medicine physician, and at least two nurses, one of who acts as the scribe. Absolute responsibility for the patient rests with the team leader. The team leader will have assigned specific duties to other members of the team. For example, the leader may assign the physician at the head of the patient and either the anesthesiologist or emergency medicine physician to manage the airway. The surgeon on the patient’s right side may be assigned the responsibility of evaluating the neck, chest, right-sided extremities, and the patient’s back. The surgeon on the left side may be assigned the duties of evaluating the abdomen and perineum, 36 Ramenofsky left-sided extremities, and neurological status. Such a setup provides for rapid and accurate initial assessment of the injured patient. Other physicians will be part of the trauma team but not necessarily part of the physician group who initially responds upon the patient’s arrival. Clearly, Orthopedic Surgery and Neurosurgery must be included in this group. Also, Plastic Surgery, Ear Nose Throat, Urology, and Ophthalmology will be required in specific cases. These individuals must be available on short notice at the behest of the trauma team leader. Nonsurgical physicians are also included in the requirements. Pediatric emergency medicine and pediatric intensive care physicians are included in this group, as are radiologists. Others whose expertise may be required include gastro- enterologists, cardiologists, neurologists, infectious disease specialists, and general pediatricians. Nurses The nurses in the resuscitation room have established duties. One will serve the function of the scribe and will record everything that occurs with the patient. The second nurse prepares the room before the patient arrives, and makes sure that appropriate fluids, chest tubes and chest evacuation apparatus, IV fluids, urinary catheters, suture material, surgical trays, etc., are available and in the room. It is also this nurse’s responsibility to make sure that the room temperature is adequate so that hypothermia does not supervene. Intensive care nurses with education, training and/or experience, and expertise in pediatrics are required in the PICU setting. Methods of training are discussed later in this chapter. Laboratory and Radiological Technicians These technicians are an integral part of the trauma team meeting the patient in the ED. Most trauma centers have a routine laboratory panel that is ordered on every patient. Technicians being present at the time the patient arrives shortens the length of time the team must wait for various laboratory results. As with laboratory studies, most injured patients require, at a minimum, a specific group of X rays, including lateral cervical spine, chest, and abdominal films. The presence of the X-ray technician with the X-ray machine shortens waiting time. When more sophisticated studies are warranted, such as CT scans or angiography, the technicians are helpful in organizing them. Social Work The stress on a family resulting from a serious injury or death of a child is significant. The presence of social services in the ED, should either occur, is comforting for the family and can function as a bridge for information when the trauma surgeons are busy providing the necessary care. EDUCATION Physician education in trauma care is quite obvious for surgeons. Nearly all surgical specialties have, as part of their educational curriculum, a section devoted to care of Organizing the Hospital for Pediatric Trauma Care 37 [...]... of Pediatric Trauma 59 19 Ushay HM, Notterman DA Pharmacology of pediatric resuscitation [review] [ 129 Refs] Pediatr Clin North Am 1901; 44 :20 7 23 3 20 Talbott GA, Winters WD, Bratton SL, O’Rourke PP A prospective study of femoral catheter-related thrombosis in children Arch Pediatr Adolesc Med 1901; 149 :28 8 29 1 21 Fiser DH Intraosseous infusion [review] [59 Refs] N Engl J Med 1901; 322 :1579–1581 22 ... continuously be Table 4 Chest Tube Size (French) Size of patient (kg) 40 Pneumothorax Hemothorax 8–10 10– 12 12 16 16 20 20 24 10– 12 12 16 16 20 20 28 28 –36 52 Letton monitored to avoid hypotension and determine the need for thoracotomy In general, loss of more than 20 7 mL/kg of blood from the chest with continued bleeding should be addressed surgically Although a true flail chest is rare... Effect of out-of-hospital pediatric endotracheal intubation on survival and neurological outcome: a controlled clinical trial [see comments] [published erratum appears in JAMA 20 00 Jun 28 ; 28 3 (24 ): 320 4] JAMA 20 00; 28 3(6):783–790 6 Martin SE, Ochsner MG, Jarman RH, Agudelo WE, Davis FE Use of the laryngeal mask airway in air transport when intubation fails J Trauma Inj Infect Crit Care 1900; 47:3 52 357 7... children managed in an adult level I trauma center J Pediatr Surg 1900; 29 :11–18 3 Knudson MM, Shagoury C, Lewis FR Can adult trauma surgeons care for injured children? J Trauma Inj Infect Crit Care 1900; 32: 729 –737 4 Nakayama DK, Gardner MJ, Rowe MI Emergency endotracheal intubation in pediatric trauma Ann Surg 1900; 21 1 :21 8 22 3 5 Gausche M, Lewis RJ, Stratton SJ, Haynes BE, Gunter CS, Goodrich SM,... in the injured pediatric patient J Pediatr Surg 20 00; 35(1): 82 87 9 Dowd MD, McAneney C, Lacher M, Ruddy RM Maximizing the sensitivity and specificity of pediatric trauma team activation criteria Acad Emerg Med 20 00; 7(10): 1119–1 125 PART II: GENERAL PRINCIPLES OF RESUSCITATION AND SUPPORTIVE CARE 4 The ABCs of Pediatric Trauma Robert W Letton Pediatric Trauma and Burns, Brenner Children’s Hospital,... in pediatric blunt trauma Ann Emerg Med 1900; 23 : 122 9– 123 5 14 Li G, Tang N, DiScala C, Meisel Z, Levick N, Kelen GD Cardiopulmonary resuscitation in pediatric trauma patients: survival and functional outcome J Trauma Inj Infect Crit Care 1900; 47:1–7 15 Siegel JH, Rivkind AI, Dalal S, Goodarzi S Early physiologic predictors of injury severity and death in blunt multiple trauma Arch Surg 1901; 125 :498–508... on Trauma Resources for the Optimum Care of the Injured Patient 1993 6 Ramenofsky ML Standards of care for the critically injured pediatric patient J Trauma 19 82; 22 (11): 921 – 923 7 The American College of Surgeons, Committee on Trauma Advanced Trauma Life Support for Physicians 1997 8 Engum SA, Mitchell MK, Scherer LR, Gomez G, Jacobson L, Slotkin K, Grosfeld JL Prehospital triage in the injured pediatric. .. adults in several specific areas relevant to trauma care Infants and young children, in particular, have a relatively large body-surface-area-to-body-cellmass ratio and are thus prone to developing hypothermia This is particularly true when exposed for resuscitation or operation or when given large volumes of intravenous fluids or blood products To prevent hypothermia, it is important to keep injured... Weight (kg) (beats/min) 3–6 12 16 35 160–180 160 120 100 Pressurea (mmHg) Respirations (breaths/min) Urine output (mL/kg/hr) 60–80 80 90 100 60 40 30 20 2 1.5 1 0.5 a Systolic blood pressure should be 80 þ 2 age (yrs) Source: Taken from Advanced Trauma Life SupportÕ for Doctors Instructor Manual in a young child A 20 0-mL estimated blood loss in a 10-kg child is equal to 25 % of their blood volume Children... American:39– 42 11 Fabian TC, Davis KA, Gavant ML, Croce MA, Melton SM, Patton JHJ, Haan CK, Weiman DS, Pate JW Prospective study of blunt aortic injury: helical CT is diagnostic and antihypertensive therapy reduces rupture Ann Surg 1901; 22 7:666–676 12 Beaver BL, Colombani PM, Buck JR, Dudgeon DL, Bohrer SL, Haller JAJ Efficacy of emergency room thoracotomy in pediatric trauma J Pediatr Surg 1900; 22 :19 23 13 . Can adult trauma surgeons care for injured children? J Trauma 19 92; 32: 729 –739. 49. Fortune JM, Sanchez J, Graca L, et al. A pediatric trauma center without a pediatric surgeon: a four-year outcome. care for the critically injured pediatric patient. J Trauma 19 82; 22 (11): 921 – 923 . 7. The American College of Surgeons, Committee on Trauma. Advanced Trauma Life Sup- port for Physicians. 1997. 8 American Heart Association, 20 02: 253 28 6. 20 . Tepas JJ, Fallat ME, Moriarty TM. Trauma. In: Gausche-Hill M, Fuchs S, Yamamoto L, eds. Advanced Pediatric Life Support: The Pediatric Emergency Medicine

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