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Question: Trauma
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You are seeing a 6 year old child that was involved in a motor vehicle accident. He was belted in the rear left seat using a regular adult seatbelt. He is alert and crying. His airway is open, there is no evidence of head trauma, trachea is midline, and chest rise is equal with no increased work of breathing. He is tender in the right upper quadrant of his abdomen and has a seatbelt sign across his mid-abdomen. He has no obvious extremity deformities. GCS is 14. His vital signs are HR 160, RR 30, BP 80/40, O2 sat 98% on 5L by face mask non-rebreather.
Kelly October 11, 2022 - 11:38 pm
B) Place 2 large-bore IV lines
ABC’s take priority in management. The patient’s airway is open in that he is alert and crying, and he shows no signs of breathing impairment. He is tachycardic and hypotensive (lower limit of systolic blood pressure defining hypotension is 70 + 2 (age of 6) = 82), and shows evidence of abdominal trauma. Placing two large-bore IV lines is the priority in management. Although O negative blood may be needed, resuscitation will start with crystalloid fluid (typically normal saline or lactated ringers). Although a FAST scan could be helpful in localizing a source of blood loss, resuscitation is the priority at this time. Pain management is also important, but again, resuscitation is the priority, and an opiate given prior to fluids could exacerbate hypotension and hypoperfusion.