EMT Exam: Tips for Dealing with Trauma Situations with a Pediatric Patient

Trauma is the number-one killer of children in the United States and a topic you should know for the EMT exam. In general, infants and toddlers are most commonly hurt through falls or abuse. In suspected abuse, there may be multiple bruises in various stages of healing.

The caregiver may provide a history of the patient being “accident prone.” Injury patterns may be too precise — scald injuries to just the buttocks and legs of an infant, for example.

School-age and adolescent children tend to be hurt through blunt trauma mechanisms involved primarily in automobile crashes or being hit by a motor vehicle while walking or riding a bicycle. Though less frequent, adolescent children are also victims of gunshots and stabbings. Contact sports are another common cause of injuries in children.

Managing pediatric trauma is similar to handling adult trauma. Your focus is to

• Preserve the airway and protect the spine.

• Ensure adequate ventilations and oxygenation.

• Minimize the effect of shock by maintaining body temperature and keeping the patient still.

Head, brain, and spinal injuries

Head and brain injuries are common in children due to the relative larger size and weight of the head. Look for signs of injury to the head and scalp, and control any external bleeding. Signs of increasing cerebral pressure (ICP) include altered mental status, headache, and vomiting.

Severe ICP may cause the brain to compress, causing unequal pupils and slowing pulse and respiratory rates. Treatment includes providing spinal precautions, preserving airway and breathing, and performing mild hyperventilation in severe ICP.

While spinal injuries are relatively less common in young children, assessing them in the field can be difficult due to communication issues. Even appropriately sized equipment may be difficult to apply due to sizing and shape issues.

Use plenty of padding to help secure the patient to an appropriately sized board. If the child presents in a car seat, consider placing padding around the patient’s head and body and immobilize the child within the seat itself, so long as the seat has not been damaged by the crash.

Chest and abdominal injuries

The chest wall is more pliable in children than in adults. This pliability provides less protection to the heart, lungs, and upper abdominal organs such as the liver and spleen. If there is a mechanism of injury (MOI) to the chest, evaluate carefully for signs of internal injury, such as respiratory distress and shock.

The developing abdominal muscles provide little protection for the organs that lie underneath. As a result, abdominal injuries are more common in children with blunt MOI. Children can mask shock symptoms for some time; evaluate the MOI and assess for possible hidden injuries.

Falls and burns

As toddlers master the act of walking, falls are common and can sometimes result in bone fractures. Suspect a fracture if the child guards the injury site, can’t put weight on a leg, or is unable to move an extremity without discomfort. Fractures may be incomplete because the child’s bones are more pliable than those of an adult. Splint any possible fracture the same way you would an adult fracture.

Burns can be especially harmful to children, as their skin is thinner and offers less protection than adults’ skin. Treat burns as you would in an adult: Extinguish any burning process first, and then dry and cover with dry, clean dressings to help with pain control. Chemicals may need to be flushed with copious amounts of water. Be careful of your own safety with electrical burns.

The rule of nines in estimating burn surface area (BSA) changes slightly for children to accommodate for different body proportions.

Disaster management for multiple patients

In disaster management, you can use the JumpSTART method to triage children under the age of 8 years and weighing less than 100 pounds.

• Patients who can walk are first categorized as “green” and sent over to the treatment area, where they can be re-triaged.

• Patients with a spontaneous breathing rate between 15 and 45 breaths per minute, a palpable pulse, and an appropriate level of consciousness are categorized as “yellow” and are delayed treatment and transport.

• Patients whose breathing rate is less than 15 or greater than 45, or who begin breathing after airway positioning and five rescue breaths, are categorized as “red” and are treated and transported immediately. This immediate category also includes patients who are breathing, but do not have a palpable pulse, as well as patients who are unconscious or altered.

  

  Credit: Courtesy of Lou E. Romig MD, FAAP, FACEP