Multiple Trauma Pediatric

 

History:

 

  • Time and mechanism of injury
  • Height of any fall
  • Damage to structure or vehicle
  • Location in structure or vehicle
  • Others injured or dead
  • Speed and details of MVC
  • Restraints / Protective equipment
  • Car Seat
  • Helmet
  • Pads
  • Ejection
  • Past medical history
  • Medications

 

Signs and Symptoms

 

  • Pain, swelling
  • Deformity, lesions, bleeding
  • Altered Mental Status
  • Unconscious
  • Hypotension or shock
  • Cardiac/Respiratory Arrest

 

Differential (Life Threatening)

 

  • Chest
  • Tension pneumothorax
  • Flail chest
  • Pericardial tamponade
  • Open chest wound
  • Hemothorax
  • Intra-abdominal bleeding
  • Pelvis / Femur fracture
  • Spine fracture / cold injury
  • Head injury (see Head Trauma)
  • Extremity fracture / dislocation
  • HEENT (Airway obstruction)
  • Hypothermia

 

 

 

    • Vital Signs including GCS

 

Vital Signs Abnormal ?

 

  • Yes

 

    • Rapid Transport to appropriate destination
    • Limit Scene Time to 10 minutes
    • Provide Early Notification.

 

 

 

    • Splint Suspected Fractures
    • Control External Hemorrhage

 

 

 

    • IV Protocol
    • Normal Saline Bolus
    • May Repeat for hypotension

 

Vital Signs Normal ?

 

  • Yes

 

 

 

 

    • Splint Suspected Fractures

 

    • Transport to appropriate destination.

 

 

 

    • Continually Reassess
    • Notify Destination or Contact Medical Control

 

Pearls

 

  • Recommended Exam: Mental Status, Skin, HEENT, Heart, Lung, Abdomen, Extremities, Back, Neuro
  • Items in Red Text are key performance measures used in the EMS Acute Trauma Care Toolkit
  • Mechanism is the most reliable indicator of serious injury. Examine all restraints / protective equipment for damage.
  • If prolonged extrication or serious trauma consider air transportation for transport times.
  • Do not overlook the possibility for child abuse.
  • Scene times should not be delayed for procedures. These should be performed en rout when possible.
  • Bag valve mask is an acceptable method of managing the airway if pulse oximetry can be maintained above 90%.
  • Coroner Notification for High Morbidity Cases
  • In cases in which EMS personnel believe that patient death may be imminent as a result of unnatural causes, the Coroner's Office shall be notified. This notification should be accomplished as soon as reasonably possible. It is the responsibility of the EMS Paramedic to communicate the patient condition with RTS to the EMS Communications Center in order that the Communication Center Staff can notify the On-Duty Coroner.

NREMR

National Registry Emergency Medical Responder

NREMR

National Registry Emergency Medical Responder

NREMT-I

National Registry EMT-Intermediate

NREMR

National Registry Emergency Medical Responder

NREMR

National Registry Emergency Medical Responder