Pediatric Trauma Pearls: Airway, Shock, and Burns with Big T Trauma

Pediatric Airway Management

• 💡 Pediatric patients are not small adults; they have unique anatomy and physiology that requires specific approaches to airway management.
• ⚠️ A common pitfall is the delay in intubation due to difficulty estimating weight-based medication dosing, highlighting the need for pre-established systems like the Broselow tape or Handy system.
• 🚀 In cases of severe airway obstruction with inability to oxygenate, needle cricothyrotomy is a critical intervention, particularly for children under 8 years old.
• 🧠 The "six Ps" of pediatric airway management are crucial: Preparation, Preoxygenation, Paralysis, Placement, and Post-intubation confirmation.

Recognizing and Managing Pediatric Shock

• ⚡ Pediatric patients can compensate for shock longer than adults due to sympathetic reserve, meaning hypotension is a late sign of decompensation.
• 📌 Subtle signs like tachycardia, cool extremities, delayed capillary refill, and altered mental status are critical indicators of compensated shock.
• 🩸 In pediatric trauma, blood is king; activating Massive Transfusion Protocols (MTP) and administering blood products rapidly is essential.
• ⚠️ Underestimating burn wound size in children can lead to hypothermia and hypovolemic shock due to their higher surface area to volume ratio and thinner skin.

Pediatric Trauma Interventions and Access

• 🎯 For pediatric patients with significant bleeding, balanced resuscitation with a 1:1:1 ratio of RBCs, FFP, and platelets is recommended, similar to adults.
• 🏥 Establishing vascular access in pediatric trauma can be challenging; options include large bore IVs (even 22 gauge in infants), intraosseous (IO) lines in the tibia or humerus, and saphenous vein cutdowns.
• 🩺 When managing pediatric thoracic trauma, chest tube size is critical, typically ranging from 12-24 French, with smaller bore options for very young children.
• 🗣️ Effective communication with parents is paramount when performing procedures on pediatric patients, explaining the intervention, pain management, and expected outcomes.

Burn Management in Children

• 🔥 For burns greater than 10% TBSA in children, aggressive fluid resuscitation is necessary, often using the Lund-Browder chart for accurate estimation.
• 🌡️ Maintaining euthermia is crucial, using warmed fluids, warming blankets, and monitoring temperature closely to prevent hypothermia.
• 💧 Close monitoring of urine output (greater than 1 cc/kg/hr) is a key endpoint for resuscitation in pediatric burn patients, alongside lactate levels and hemodynamics.
• 🍜 Early initiation of enteral nutrition is vital for pediatric burn patients to support their metabolic needs and prevent complications.