Pediatric Trauma Care: A Practical Guide

Preface
Contents
Chapter 1: Introduction: (Unique Factors to Pediatric Trauma)
	Introduction
	Trauma Organizations
	Training Opportunities
	Conclusions
	References
Chapter 2: Injury Prevention
	Conclusions and Take Home Points
	References
Chapter 3: Trauma Systems and Pediatric Trauma Centers
	History of the Trauma System
	Overview of the Trauma System
	Prehospital Trauma Care
	Interhospital Transfer
	Qualifications of a Pediatric Trauma Center
	Value of Pediatric Trauma Center Verification
	Conclusion
	References
Chapter 4: Rural Trauma
	Definition
	Disparities
	Unique Injuries
		Mechanisms
	Firearm Injuries
	Farm Injuries
	Anabaptist
	All-Terrain Vehicle (ATV)/Utility Terrain Vehicle (UTV)
	Lawnmower
	Non-accidental Trauma (NAT)
	Conclusions and Take Home Points
	References
Chapter 5: Disaster Management
	Introduction
	The Five Phases of Disaster Management
		Prevention
		Mitigation
		Preparedness
		Response
		Recovery
	The Incident Command Structure
	Specific Considerations in Mass Casualty Events
		Immediate Triage
		Transportation
		Hospital Based Triage
		Real World Example
	Conclusion
	References
Chapter 6: Paediatric Trauma in Settings of Limited Resource
	Introduction
	Initial Assessment and Management
	Airway and Ventilatory Management
	Shock
	Thoracic Trauma
	Abdominal Injury
	Head Trauma
	Spine and Spinal Cord Trauma
	Musculoskeletal Injuries
	Vascular Injury
	Thermal Injuries
	Caustic Ingestion
	Intentional Violence
	Conclusion
	References
Chapter 7: Initial Trauma Resuscitation
	Airway
	Breathing
	Circulation
		Pathophysiology
		Access
		Resuscitation
		Adjunct Treatments
		Predictive Scoring for Transfusion
		Viscoelastic Monitoring
	Disability/Exposure
	Conclusions and Take Home Points
	References
Chapter 8: Airway Management in Pediatric Trauma
	Introduction
	Upper Airway Anatomy
	Airway Assessment
	Airway Management
	Surgical Airway
	Conclusion/Take Home Points
	References
Chapter 9: Shock in the Pediatric Trauma Patient
	Conclusions and Take Home Points
	References
Chapter 10: Massive Transfusion in the Pediatric Trauma Patient
	Epidemiology
	Trauma Induced Blood Failure
	Crystalloid Versus Blood
	Component Therapy, Ratios
	Whole Blood
	Adjuvants
		Tranexamic Acid
		Recombinant Factor VIIa
		Cryoprecipitate
		Prothrombin Complex Concentrate
		Thromboelastography (TEG) and Rotational Thromboelastometry (ROTEM)
	Delivery
		Access
		Rapid Transfusers
		Storage
	Complications
	Metabolic Derangements
	Transfusion Reactions
	Immunological Complications
	Hypothermia
	How to Guide: Development of a Massive Transfusion Protocol
	Barriers to Establishing and Implementing a Massive Transfusion Protocol
	Conclusions and Take Home Points
	References
Chapter 11: VTE Prophylaxis and Treatment
	Introduction
	Background and Epidemiology
	Complications Associated with VTE
	Risk Factors
	Methods of Prophylaxis: Mechanical Vs Chemical
	Important Considerations
	Risk Stratification Tools: Classifying Between High and Low Risk Pediatric Patients (Table 11.1)
	Current Pediatric Trauma Society Recommendations
	Conclusions
	References
		Further Reading
Chapter 12: Surgical Nutrition
	Narrative
		Physiologic Response to Trauma
	Nutritional Support
		Nutritional Assessment and Development of Feeding Protocol
		Estimation of Energy and Protein Needs
	Route of Nutritional Support
		Enteral Nutrition (EN)
			Gastric Vs. Post-pyloric Feeding
			Trophic Feedings
	Parenteral Nutrition (PN)
	Considerations Based Upon Mechanism of Injury
	Timing/Initiation of Nutritional Support
	Choice of Formula
		Formula Supplementation
	Monitoring of Nutritional Support
		Underfeeding
		Refeeding Syndrome [24]
		Overfeeding [3]
	Challenges to Delivering Adequate Nutrition
	Conclusions
	References
		Further Reading
Chapter 13: Thromboelastography: An Overview
	Introduction
	Principles
	Thromboelastography Assay Types
	Clinical Utility
	Conclusions and Future Directions
	References
Chapter 14: Pediatric Traumatic Brain Injury
	Pediatric Traumatic Brain Injury
		Epidemiology
		Classification of Pediatric TBI
		Etiologies and Injury Patterns in Pediatric Traumatic Brain Injury
		Initial Evaluation of Pediatric Traumatic Brain Injury
			Mild Traumatic Brain Injury
			Moderate Traumatic Brain Injury
			Severe Traumatic Brain Injury
		Clinical Management of the Pediatric TBI Patient
			Management of Pediatric Mild TBI
			Medical Management of Pediatric Moderate-Severe TBI
			Surgical Management of Pediatric Traumatic Brain Injury
	Conclusions
	References
Chapter 15: Pediatric Facial Trauma
	Radiographic/Ancillary Studies
	Pediatric Facial Trauma
		Skull Fracture
		Orbital Roof
			Orbital Floor Fractures
			Nasal Fractures
			Midface
			Mandible
			Soft Tissue
			Facial Nerve
			Dog Bite
			Burn
		Psychosocial Care
	Tables
	Conclusions
	References
Chapter 16: Neck Injuries
	Initial Management of the Trauma Patient
	Background and Incidence
		Clinical Considerations
			Larynx
			Vascular
			Esophagus
	Mechanisms of Injury
		Blunt Neck Trauma
			Laryngotracheal Injury
			Vascular Injuries
			Esophageal Injuries
		Penetrating Neck Trauma
	Laryngeal Trauma—Workup and Management
		Clinical Presentation
			Classic Symptoms
			Classic Signs
			Flexible Fiberoptic Signs
		Imaging
		Management of Injuries
			Goals
		Medical Therapy
		Surgical Therapy
	Vascular Trauma—Workup and Management
		Clinical Presentation
			Hard Signs and Symptoms
			Soft Signs and Symptoms
		Imaging
		Management of Injuries
			Goals
		Medical Therapy
		Surgical Therapy
	Esophageal Trauma—Workup and Management
		Clinical Presentation
			Hard Signs and Symptoms
			Soft Signs and Symptoms
		Imaging
		Management of Injuries
			Goals
			Medical Therapy
			Surgical Therapy
	Conclusions and Take Home Points
	References
Chapter 17: Traumatic Spinal Injuries in Children
	Epidemiology
	Etiology
	Pediatric Spine
	Clinical Features
	Diagnosis
		History & Physical
	Imaging Guidelines
	Screening Imaging Studies
	Initial Management
	Fracture Patterns and Radiographic Abnormalities
		Atlanto-Occipital Dissociation
		Odontoid Fracture
		Atlanto-Axial Rotatory Fixation
		Subaxial Cervical Spine Injuries
		Compression Fractures
		Flexion-Distraction Fractures (i.e., Chance Fractures)
		Burst Fractures
		Vertebral Apophysis Fractures
		Slow Vehicle Crush Fractures
		Spondylolisthesis/Spondylolysis
		Spinous Process or Transverse Process Fractures
		C2–C3 Psuedosubluxation
	Neurologic Injuries
		Anterior Spinal Cord Syndrome
		Posterior Spinal Cord Syndrome
		Central Spinal Cord Syndrome
		Brown-Séquard Syndrome
		Cauda Equina Syndrome
		Spinal Cord Injury Without Radiographic Abnormality (i.e., SCIWORA)
	Special Considerations
		Unconscious Patients
		Child Abuse
		Persistent Pain with Exam and Radiographs
	Outcomes
	Conclusions and Take Home Points
	References
Chapter 18: Thoracic and Chest Wall Injuries
	Initial Assessment and Management of the Trauma Patient
	Radiographic/Ancillary Studies
		Chest Radiograph
		Ultrasound
		Computed Tomography (CT) Scan
	Management of Specific Injuries
		Rib Fractures
			Management
		Flail Chest
			Management
		Pulmonary Contusion
			Management
		Pneumothorax
			Management
		Hemothorax
			Management
			Retained Hemothorax
		Esophageal Injury
			Management
		Diaphragm Rupture
			Management
	Conclusions
	References
Chapter 19: Penetrating Abdominal Injury
	Initial Management of Trauma Patient
	Initial Radiographic/Ancillary Studies
		Laboratory Studies
		Radiographic Studies
			Epidemiology
		Etiology
			Firearm Injury
			Cut/Pierce Injury
			Injury Patterns
		Treatment
			Laparotomy
	Alternatives to Laparotomy
		Emerging Adjuncts
		Outcomes
			Survival
			Morbidity
	Conclusions and Take-Home Points
	References
Chapter 20: Liver Injury
	Initial Management of Trauma Patient
	Initial Radiographic/Laboratory Studies
		Non-operative Management
		Operative Intervention
		Complications of Liver Trauma
		Discharge and Follow-up
	Conclusions and Take Home Points
	References
Chapter 21: Pancreas, Duodenum and Biliary Tree
	Biliary Tree Injuries
	Duodenum
	Pancreas
	Conclusions
	References
Chapter 22: Splenic Trauma
	Introduction
	Initial Management of Trauma Patient with this Injury
	Radiographic/Ancillary Studies
	Nonoperative management
		Length of Stay
		Transfusion Requirement
		Associated Injuries
		Activity Restriction
		Follow-up Imaging Studies
	Operative Management
	Angioembolization
	OPSI/Vaccinations
		Guidelines
	Conclusions and Take Home Points
	References
Chapter 23: Gastric Injury
	Initial Assessment
	Laboratory and Radiologic Evaluation
	Management
	Operative Exposure Techniques: [14]
	Surgical Management: [1, 14]
		Intraoperative Pearls
	Post-operative Management and Complications [1, 14]
	Conclusions and Take Home Points
	References
Chapter 24: Small Intestine and Colon
	Initial Management of Trauma Patient
	Initial Radiographic/Ancillary Studies
	Introduction/Epidemiology
	Mechanism
	Diagnosis
		Physical Exam
		Serum Laboratory Considerations
		Imaging
		Grading Scales
	Management
		Small Intestine
		Colon
	Post-operative Care and Outcomes
	Conclusion
	References
Chapter 25: Rectal Injury
	Initial Management of the Trauma Patient
	Initial Radiographic/Ancillary Studies
		Initial Assessment
			Physical Exam
			Plain Films
			Imaging/Studies
		Management
			Intraperitoneal Rectal Injury
			Extraperitoneal Rectal Injury
			Fecal Diversion
	Conclusions and Take Home Points
	References
Chapter 26: Perineal Injury
	Initial Management of the Trauma Patient with Perineal Injury
	Initial Radiography/Ancillary Studies
	Pediatric Perineal Injury
		Epidemiology
		Mechanism and Classification of Perineal Injuries
		Straddle Injury
		Non-straddle Blunt Injury
		Penetrating Injury
		Sexual/Coital Injury
		Radiographic Evaluation
		Operative Evaluation
		Operative Repair
	Conclusions and Take Home Points
	References
Chapter 27: Upper Tract Genitourinary Trauma
	Renal Trauma
		Introduction
		Diagnosis
		Management
	Ureteral Trauma
		Introduction
		Diagnosis
		Management
	Conclusion
	References
Chapter 28: Lower Tract Genitourinary Trauma
	Initial Management of the Trauma Patient
	Initial Radiographic/Ancillary Studies
		Bladder Trauma
			Classification and Diagnosis
			Management and Follow-Up
		Urethral Trauma
			Classification and Diagnosis
			Management and Follow Up: Posterior Urethra
			Management and Follow-Up: Anterior Urethra
		Female Urethral Trauma
		Genital Trauma
			Male Genital Trauma
			Female Genital Trauma
			Pediatric Genital Trauma and Abuse
	Conclusions and Take Home Points
	References
Chapter 29: Pediatric Hip and Pelvis Trauma
	Pertinent Anatomy
		Mechanism of Injury
		Initial Exam
		Associated Injuries
	Pelvic Ring Injuries
	Acetabular Fractures
	Hip Dislocation
	Reduction Maneuvers
		Anterior/Obturator Dislocation
		Posterior Dislocation
	Proximal Femoral Fractures
	Avulsion Fractures
	Outcomes
	Conclusion and Take Home Points
	References
Chapter 30: Pediatric Extremity Injuries
	Mechanism of Injury
	Initial Exam
	Non-Accidental Trauma
	Physeal Injury
	Upper Extremity Injuries
		Elbow
	Lower Extremity
		Ankle
	Conclusion
	References
Chapter 31: Injuries to the Hand
	Compartment Syndrome of the Hand
	Acute Carpal Tunnel Syndrome
		High Velocity Injection Injury
		Fractures & Dislocations
			Open Fractures
			Carpal Fractures
				Scaphoid Fractures
			Metacarpal Fractures.
				Metacarpal Shaft Fractures
				Metacarpal Neck Fractures (“Boxer’s Fractures”)
			Phalangeal Fractures.
				Intraarticular Condylar Split Fractures
				Phalangeal Neck Fractures
				Phalangeal Shaft fractures
				Proximal Phalangeal Base fractures
			PIP Joint Fracture-Dislocations
				Mallet Finger
				Jersey Finger
		Nailbed Injuries and Amputations
			Nailbed Injuries/Tufts Fractures
				Seymour fracture
			Amputations
		Tendon and Neurovascular Injuries
			Extensor Tendon Injuries
			Flexor Tendon Injuries
			Neurovascular Injuries
		Miscellaneous
			Animal Bites
		Bedside Procedure Techniques
	Conclusions and Take Home Points
	Further Reading
Chapter 32: Vascular Injuries to the Heart and Great Thoracic Vessels
	Initial Evaluation and Management
	Initial Radiographic/Ancillary Studies
	Overview
	Cardiac Injuries
		Penetrating Cardiac Trauma (Image 32.1)
		Blunt Cardiac Trauma (Image 32.2)
		Great Vessel Injuries
		Penetrating Great Vessel Injuries
		Specific Injuries
		Blunt Great Vessel Injuries
		Specific Injuries
	Conclusions
	References
Chapter 33: Vascular Injuries of the Abdominal Vessels
	Introduction: Initial Management of Trauma Patient: Vascular Injury Consideration
	Abdominal Vascular Injury
		Aorta
		Inferior Vena Cava
		Renal
		Retroperitoneum
		Mesenteric Vessels
	Role of Endovascular Therapy
	Outcomes
	Conclusion
	References
Chapter 34: Vascular Injuries of the Extremity
	Introduction
	Initial Evaluation and Management
	Diagnosis
	Management
	Conclusion
	References
Chapter 35: Envenomation, Bites and Stings
	Initial Management of Trauma Patient with Envenomation, Bites and Stings
	Radiographic/Ancillary Studies
	Bites and Stings
	Mammal Bites
		Human Bites
		Dog Bites
		Cat Bites
		Rabies
		Snake Envenomation
	Medical Management
	Operative Management
	Arachnid Bites
		Scorpions
		Spiders
	Conclusions
	References
		Further Reading
Chapter 36: Child Abuse
	Introduction
	Epidemiology
	Presentation
		Sentinel and Escalation Injuries
		Screening and Algorithms
		History
		Physical Exam
		Radiographic Findings
		Management
	Evaluation and Management by Injury Pattern
		Bruises
		Abusive Head Trauma
		Skeletal Injuries
		Abdominal Injuries
		Burns
	Conclusions and Take Home Points
	References
Chapter 37: Hypothermia and Near-Drowning
	Introduction
	Physiology of the Hypothermic and Near-Drowning Victim
	Management of the Hypothermic and Near-Drowning Victim
	Prevention and Suspicious Injury Patterns
	Conclusion
	References
Chapter 38: Pediatric Burn Injury
	Demographics and Burn Mechanism by Age
		Pathophysiology
		Classification
			Inhalational Injury
			Electrical Injury
			Chemical Injury
	Outpatient and Non-Surgical Burn Management
		Wound Cleaning and Debridement
		Application of Dressings
		Follow-Up
		Adjunctive Therapies
	Surgical Burn Management
		American Burn Association Designated Burn Center Transfer Criteria
		Burn Wound Complications
	Conclusions and Take Home Points
	References
Chapter 39: New Technologies in Pediatric Trauma
	Introduction
	REBOA for Pediatric Systemic Hemorrhage Control
	Direct Site Endovascular Hemorrhage Control and Repair
	POCUS of ONSD for ICP Monitoring
	Lung POCUS for PARDS
	Pulse Co-Oximetry for Management of Solid Organ Injury
	Conclusions and Take Home Points
	References
Index