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[Polytraumatised children]
Insights
Pediatric trauma requires coordinated care from accident scene to rehabilitation. Prompt evaluation of airway, breathing, and circulation is crucial for managing head, thoracic, and abdominal injuries to prevent long-term neurological deficits.
Area of Science:
- Pediatric Trauma Management
- Emergency Medicine
- Pediatric Surgery
Context:
- Trauma is a leading cause of mortality in children aged 1-14 years globally.
- Effective management necessitates a coordinated chain of care from initial response to long-term rehabilitation.
- Industrialized nations face significant challenges in pediatric trauma care organization.
Purpose:
- To outline essential initial management strategies for pediatric trauma patients.
- To detail the systematic evaluation of anoxia, hypovolemia, and neurological distress.
- To define criteria for emergency operative procedures versus comprehensive clinical and radiological assessment.
Summary:
- Initial assessment focuses on hemodynamic stability, anoxia, hypovolemia, and neurological status.
- Management strategies differentiate between unstable and stable patients, guiding decisions for operative intervention or detailed evaluation.
- Key considerations include managing intracranial pressure (ICP) in head trauma and non-operative approaches for abdominal injuries, emphasizing rigorous hemodynamic monitoring.
Impact:
- Optimized initial management can prevent secondary brain injury and improve outcomes in pediatric trauma.
- Non-operative management of abdominal trauma, particularly splenic and liver injuries, can be safely achieved in over 90% of cases with close monitoring.
- Early diagnosis and appropriate intervention for conditions like pneumothorax, pulmonary contusion, and intestinal perforation are critical for survival.
Abstract:
Trauma is the leading cause of mortality in children between the ages of 1 and 14 years. It represents a major health problem in all industrialized countries. A well coordinated organization of the whole chain of cares is essential, from the initial management at the scene of the accident until the long term neurological rehabilitation of the child. During the initial examination, the presence of anoxia, hypovolemia or neurological distress was systematically evaluated. Emergency therapeutic measures should be ensured. At the term of this initial management: if the haemodynamic state is unstable, an emergency operative procedure may be required; if the haemodynamic state remains stable, one can realize a complete clinical and radiological assessment. The clinical and biological supervision must continue during this evaluation while sedation and analgesia are essential to limit an increase in intracranial pressure (ICP). At the term of this complete assessment, if one or several surgical lesions are identified, an operative program with a precise hierarchy is scheduled; if an intensive medical support is required, the child is then transferred to the pediatric intensive care unit. Most often, children with a serious head trauma do not have neurosurgical lesions but a "brain-swelling" or cerebral edema. Elevated ICP is one of the main risk for cerebral ischemia. Therefore, continuous assessment of ICP is essential. Thoracic trauma is most often a closed trauma in the child: pneumothorax and pulmonary contusion are the problems most frequently met. An emergency laparotomy is required if the abdomen volume increases rapidly associated to the persistence of a unstable haemodynamic status despite an important fluid expansion. However, the presence of intraperitoneal blood is no longer a formal indication to surgery. Frequent examination of liver and splenic lesions with abdominal tomodensitometry allows to avoid surgery in more than 90% of cases at the price of a very rigorous haemodynamic supervision. Intestinal perforations are rare and difficult to diagnose: peritoneal dialysis, if it reveals the presence of a leucocytosis greater than 500/mm3 or bacteria justifies the surgery.(ABSTRACT TRUNCATED AT 400 WORDS)