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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?
