Early management of pediatric polytrauma

Abstract

Trauma is the leading cause of death after the age of one year. Anatomical and physiological characteristics make children at risk of injuries different from adults with a high incidence of head and solid organ trauma. Immediate management is based on a structured approach to stabilize vital functions, using the ABCDE acronym. Airway management should be accompanied by a strict immobilization of cervical spine. Assessment of breathing should seek and treat pneumothorax. It is essential to correct hypoxia with adequate oxygen and usually tracheal intubation following a rapid sequence induction. Gastric distension should be prevented by the placement of a gastric tube. Hypovolemic shock should be corrected even in the absence of hypotension, which is late in children. Fluids and haemorrhage control are supplemented as required by vasopressors and transfusions. Signs of intracranial hypertension should be treated with osmotherapy after correction of hypoxia and hypovolemia. The patient should then be oriented to the most appropriate department, ideally a paediatric trauma center.