PED TRAUMA

• Severe limb-threatening trauma is rare so very few people have much experience outside the military.
• The growing skeleton reacts differently to injury than that of an adult. Although bones may remodel to near perfect anatomical alignment the blood vessels are small and thin-walled and thus vulnerable to damage.
• The smaller circulating volume of a child means a severe limb injury can lead to early shock.
• These limb-threatening injuries might distract the trauma team from the basic ABC approach though management of catastrophic haemorrhage comes first.
• Whilst direct pressure might help reduce some blood loss, tourniquets can be life and limb saving.
• Damage control resuscitation in children involves restricted crystalloid use, early use of blood products and permissive hypotension (except in the setting of head injury).
• Tranexamic acid should be considered in serious trauma in children.
• Pulsed lavage may lead to worse outcomes and forced contamination of wounds so copious warm saline lavage is more appropriate.
• Children may develop compartment syndrome with minimal external evidence of injury.
• Consider compartment syndrome if the child appears anxious, agitated and requires far more analgesia than you would expect.
• Multidisciplinary care is required to assess the viability of the limb as well as plan staged, operative management and rehabilitation.