Advanced Paediatric Life

Support
Structured approach to the seriously injured child

© ALSG, 2015
Learning outcomes

By the end of this session, you will be able to

demonstrate an understanding of:
• the structured approach to the seriously injured
child
• the clinical assessment sequence to identify life-
threatening injury in a child

© ALSG, 2015
Focus on doing the basics well

• Primary survey and

“C” ABC
resuscitation are
your priority of care
• Team management
and team control are
essential
• Secondary survey if
appropriate

© ALSG, 2015
Trauma team set up:

Trauma network
• MTC
• TU
• DGH
Depending on where you
work will depend on the
type of response you get to
a trauma call

© ALSG, 2015
Prior to arrival
Team allocation
Information sharing
Role allocation

Formulate a plan based on information and age of child

Prepare size-appropriate equipment for

Airway, Breathing and Circulation

Communication and plan next steps:

Where are you going to take the child and how?

Child arrives
Structured SBAR handover © ALSG, 2015
Patient management: Systematic approach

Primary survey – treat problems as they are found

Resuscitation – Consider DCS

Secondary survey – when/where?
Definitive care – what is the exit plan?

© ALSG, 2015
Initial assessment and management

<C>ontrol catastrophic haemorrhage

Airway (with cervical spine)
Breathing
Circulation
Disability
Exposure

© ALSG, 2015
Secondary survey

• Head to toe
• Front and back

By:
• Look
• Listen
• Feel

© ALSG, 2015
3 year old girl, Nevaeh, has been hit by a
car…
The car was travelling at Her breathing is
approximately 35 mph outside her noisy, she is
house. She has remained gurgling with
unconscious since the impact. shallow laboured
The child remains unconscious breath sounds.
but localises to pain, she has a Heart rate 100, RR
large boggy swelling over the right 32.
occiput and has blood coming
from her ear.

© ALSG, 2015
A trauma call has been made by
ambulance control…
A 15 year old girl, Katie,
has been witnessed to fall
from an upper floor
balcony. She is moaning
and unable to get up.

She is complaining that

everything hurts. She has
remained conscious
throughout: HR 100, RR
17, BP 110/80.
© ALSG, 2015
Let’s think about C-spine injuries
• Less than 1% chance of having a c-spine injury
• In younger children below the age of five, C1-C3
vertebrae are more vulnerable and more susceptible to
ligamentous injury
• Remember SCIWORA
• In the seriously injured child always presume C-spine
injury is present

Current protocols do not work

© ALSG, 2015
Trauma stabilisation

Manual
In
Line

Stabilisation

© ALSG, 2015
Trauma stabilisation

© ALSG, 2015
8 year old Mohammed has fallen from a
tree…
He was climbing a tree. The branch broke and the
child fell, landing on the railings beneath.

His brother helps him off the railings and a passer

by calls an ambulance. He is complaining of chest
pain and difficulty breathing. There is blood on his
t shirt.

© ALSG, 2015
On arrival to the scene by the
ambulance…
The boy is sitting. He is pale and breathing heavily.

Initial observations : RR 35, HR 140, CR 3 sec.

He is responding but gasping for breath.

© ALSG, 2015
On arrival at the hospital…

Initially, he is talking and complaining of chest pain.

There is a lower left penetrating injury.

Breathing has become more laboured, RR 40 with

marked recession, no breath sounds are heard on the
left side of his chest.

He is peripherally cool, CR > 5 sec, HR 150.

© ALSG, 2015
Life-threatening chest injuries

BLATOM FC
• Blast injury
• Airway obstruction
• Tension pneumothorax
• Open pneumothorax
• Massive haemothorax
• Flail chest
• (Cardiac tamponade – part of C)

© ALSG, 2015
He becomes very quiet…

Despite appropriate
treatment he continues to
deteriorate and become
very quiet.

He has a PEA ARREST.

© ALSG, 2015
14 year old Jakub attends your
department…
He was riding his bike at a
BMX park. He was wearing full
protective gear including a
helmet. He lost control and
landed on his handlebars. He
got up and continued to cycle
for a few hundred metres
On initial assessment
before he stopped and started
he is very pale, quiet
to complain of abdominal pain.
and lethargic. He is
responding to voice:
RR 20, HR 145, CR <
3 sec.
© ALSG, 2015
18 month old Lily is brought to your
department…
With a history of having fallen
down the stairs – from
top to bottom - and has been
inconsolable since.
The paramedic reports that when
they arrived on scene a 6 year old
child took them into the house. On examination, the
They found the toddler crying toddler has a very
uncontrollably at the bottom of the swollen and deformed
stairs, with her older sister (12 y) right thigh, with bruising
trying to console her. to her forehead and a
black eye. RR 36, HR
155, CR < 2 sec.
© ALSG, 2015
Advanced Paediatric Life Support
Structured approach to the seriously injured
child

© ALSG, 2015
Summary

• Focus on doing the basics well

• Primary survey and “C” ABC resuscitation are
your priority of care
• Team management and control are essential
• Secondary survey if appropriate

© ALSG, 2015