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TRAUMA - PAEDIATRIC

SHARP ABDO TRAUMA - PAEDS

PromptPotential injuries in 8yo – child vs stick on bike
ResponseThoracic:
  • Haemothorax
  • Pneumothorax
  • Pulmonary contusion or laceration
  • Diaphragmatic perforation
  • Bronchopleural fistula
  • Cardiac contusion or laceration (unlikely given clinical state)
Abdominal:
  • Hollow viscous perforation
  • Solid organ penetration (Liver, Kidney, unlikely splenic)
  • Vascular injury (IVC, abdominal aorta)
  • Ureteric laceration
Pelvic:
  • Bladder perforation
  • Uterine laceration
  • Ovarian injury
Self-rate:
PromptManagement of penetrating abdominal injury in paeds
Response
  • Seek and treat immediate life threats: haemo-pneumothorax and hypovolaemia.
  • Minimal volume resuscitation: End point: Cap refill < 2sec; PRC 10ml/kg aliquots
  • Analgesia: Parenteral most appropriate in this patient
    • Fentanyl 1mcg/kg q10 min until analgesia
    • Morphine 0.1mg/kg q 15 min until analgesia
    • Ketamine 0.2mg/kg repeat x2 if required
  • Investigations: Radiological: CXR (portable) +/- CT(chest/abdo/pelvis) if stable to define injury
  • Investigations: Bloods: VBG – for lactate; Cross match
  • Urgent notification to General/Trauma Surgeons: High risk penetrating abdominal injury; Requires OT for laparotomy.
  • IV Ab’s: Ampicillin 50mg/kg qid + Gentamicin 5mg/kg od + Metronidazole 12.5mg/kg bd
  • NBM +/- NGT
  • Check immunisation for ADT and manage accordingly
Self-rate:
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