Chapter 10 and 11

Identify unique characteristics of the pediatric, elderly and female patient

Identify unique injury patterns Discuss applications of ATLS management

principles to the unique population

Anatomic considerations◦ Narrow upper airway◦ Anterior, funnel-shaped larynx◦ Short trachea◦ Pliable soft chest wall◦ Softer thinner-walled abdomen◦ Lower-riding liver◦ Flexible spine◦ Thin skin and high ratio BSA:body mass

Sign 0 to 3 years 3 to 5 years 6 to 12 years

HR <150 – 160 <140 <100 – 120

BP >60 – 70 >75 >80 – 90

RR <40 – 60 <35 <30

Urinary output 2 mL/kg 1 mL/kg 0.5 mL/kg

Management priorities are still the same! A - Size of uncuffed ET tube B - Compliant ribs, chest tube size C - Fluid challenge, use of blood D - GCS score, pediatric verbal score E - Prevent heat loss

Physiologic changes Pre-existing diseases Medications Increasing age and decreasing organ

function

Difficult intubation: cervical arthritis, mucosal fragility

Unique breathing problems: diminished reserve, COPD, chest injuries poorly tolerated

Unique circulatory problems: fixed HR, hypertension, limited reserve, renal function, medications

Unique neuro problems: subdural hematomas, altered sensorium, spinal osteoarthritis

Exposure: increased sensitivity to hypothermia

MSK: most frequent cause of morbidity, osteoporosis, fractures, preexisting deformities, immobility may lead to complications

Is she pregnant?◦ Ask, uterine enlargement, pregnancy test

Pregnancy changes:◦ Uterus intrapelvic and thick-walled in 1st trimester◦ Uterus extrapelvic and large volume fluid in 2nd ◦ Uterus thin-walled and displaced organs in 3rd

Pregnancy risks:◦ Pelvic fractures◦ Abruptio placenta◦ Amniotic fluid embolism

A – Aspiration risk B – Hyperventilation C – Hypervolemia with anemia D - Eclampsia

A – same as non-pregnant B – Same as non-pregnant C – displace uterus/volume infusion D – Eclampsia vs brain injury E – same as non-pregnant

Resuscitate the mother Monitor fetal heart tones Consider fetal injury with

◦ Vaginal bleeding◦ Abruptio placenta◦ Uterine tenderness◦ Uterine rupture◦ labor

Is she pregnant? What are the changes? How do these changes affect injury

patterns? How do you manage both patients?