Pediatric Trauma

8. Case Resolution

Case 1.

This patient needs immediate treatment and transport. He has suffered injuries to the thorax, head, and lower extremities. Initial evaluation confirms respiratory distress and shock. Snoring is probably due to airway obstruction by soft tissue, blood, or broken teeth. Adequate positioning of the airway and suctioning may alleviate the problem. Stabilize the cervical spine immediately.

The patient presents with hypoxia, with altered influx of air due to lung contusion or
tension pneumothorax.

If the child does not respond to positive pressure ventilation and 100% oxygen, needle decompression of the right hemithorax would be indicated. Also consider endotracheal intubation if oxygenation does not improve with the less invasive airway intervention.

Stabilize the femur by splinting. On the way to the hospital, administer IV fluids for
intravascular volume expansion. Quickly refer the patient to a center with pediatric care specialized units.

Case 2.

The girl appears to have suffered an isolated head injury with cranioencephalic trauma. Her rapidly deteriorating condition suggests intracranial expansive hematoma, a potentially deadly condition. As in any traumatic brain injury, consider the risk of a spinal-associated lesion. Stabilize the dorsal spine. It is important to be alert to possible vomiting. Administration of 100% oxygen and immediate transport to a center with a neurosurgical pediatric unit by plane if there is no such facility in the area are warranted.

On the way to the hospital, place an IV access to administer medication. This is an emergency, and enabling this patient to go immediately into the operating room may make the difference between life and death.