Blood, fluids, and electrolytes in the pediatric trauma patient

Successful resuscitation of pediatric trauma patients begins with identification of the physiological abnormalities that require intervention. Health care practitioners in the prehospital, emergency room, and operating room settings must be familiar with normal physiological parameters to be able to recognize abnormalities and begin resuscitative efforts. Recognition of shock may be more subtle in the pediatric patient, because blood pressure can be maintained in the face of a marked decrease in circulating blood volume. Once recognized, shock requires aggressive treatment that must be aimed at supporting and stabilizing vital organ function. Obtaining adequate access to the vascular system to carry out resuscitation is challenging. The IO method of obtaining access is being used with greater frequency when time is critical for resuscitation, as is often the case in pediatric trauma. The area of fluid management and blood transfusion has undergone extensive change in the last decade but needs continued investigation in the pediatric trauma population. Studies targeting this population are limited, and current practices are based largely on extrapolation from adult experience and studies. The area continues to evolve, but further research is needed to improve resuscitation in the pediatric trauma patient.