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Multiple trauma in children: critical care overview
Randall C Wetzel1, R Cartland Burns
1Department of Anesthesiology Critical Care Medicine, Childrens Hospital of Los Angeles, 4650 Sunset Boulevard, MS# 12, Los Angeles, CA 90027-6062, USA.
Insights
Managing pediatric multiple trauma requires a comprehensive approach, addressing physiological and psychological aspects. Integrated trauma teams and damage control surgery are key for critically ill children with severe injuries.
Area of Science:
- Pediatric trauma care
- Systemic inflammatory response syndrome
- Critical care medicine
Background:
- Multiple trauma in children involves complex physiological and psychological challenges.
- Effective management extends beyond immediate injuries to include systemic responses and family integration.
- Healthcare providers also experience significant psychological effects when treating critically injured children.
Purpose of the Study:
- To provide an overview of the pathophysiology of multiple trauma in children.
- To outline general principles for managing pediatric multiple trauma using an integrated team approach.
- To discuss the role of damage control surgery in severe pediatric trauma cases.
Main Methods:
- Review of the pathophysiology of multiple trauma, emphasizing systemic inflammatory responses.
- Discussion of integrated trauma team principles for comprehensive patient care.
- Evaluation of damage control surgery as a management strategy for severe pediatric trauma.
Main Results:
- Multiple trauma triggers a systemic disease process with inflammatory mediators.
- A lethal triad of hypothermia, acidosis, and coagulopathy can result from trauma and secondary injury.
- Damage control surgery is a rational approach for selected children with severe abdominal vascular or visceral injuries.
Conclusions:
- Controlling secondary pathophysiological sequelae is crucial in managing multiply injured children.
- Effective pediatric multiple trauma care necessitates a multidisciplinary team, family-centered approach, organized trauma system, and quality improvement.
- Damage control surgery offers a strategic option for specific severe pediatric trauma cases.
Abstract:
Multiple trauma is more than the sum of the injuries. Management not only of the physiologic injury but also of the pathophysiologic responses, along with integration of the child's emotional and developmental needs and the child's family, forms the basis of trauma care. Multiple trauma in children also elicits profound psychological responses from the healthcare providers involved with these children. This overview will address the pathophysiology of multiple trauma in children and the general principles of trauma management by an integrated trauma team. Trauma is a systemic disease. Multiple trauma stimulates the release of multiple inflammatory mediators. A lethal triad of hypothermia, acidosis, and coagulopathy is the direct result of trauma and secondary injury from the systemic response to trauma. Controlling and responding to the secondary pathophysiologic sequelae of trauma is the cornerstone of trauma management in the multiply injured, critically ill child. Damage control surgery is a new, rational approach to the child with multiple trauma. The selection of children for damage control surgery depends on the severity of injury. Major abdominal vascular injuries and multiple visceral injuries are best considered for this approach. The effective management of childhood multiple trauma requires a combined team approach, consideration of the child and family, an organized trauma system, and an effective quality assurance and improvement mechanism.
