# Early Assessment and Management of Trauma — GCMD Library living collection

Updated: n/a · 9 episodes · 19 cited statements

## Episodes
### Tools

### Work-up and Treatment

### Updates
- [ATLS 2021 Pediatric Surgery Update](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549) — podcast · 16:05 · [machine version](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549.md)
- [Update Course Rewind: Cervical Spine Clearance 2019](https://qa.library.globalcastmd.com/watch/update-course-rewind-cervical-spine-clearance-2019-3990) — podcast · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-cervical-spine-clearance-2019-3990.md)
- [Update Course Rewind: TEG 2019](https://qa.library.globalcastmd.com/watch/update-course-rewind-teg-2019-4010) — podcast · [machine version](https://qa.library.globalcastmd.com/watch/update-course-rewind-teg-2019-4010.md)
- [Guest Podcast from EAST Traumacast: Pediatric Trauma Society 2019](https://qa.library.globalcastmd.com/watch/guest-podcast-from-east-traumacast-pediatric-trauma-society-2019-2280) — podcast · [machine version](https://qa.library.globalcastmd.com/watch/guest-podcast-from-east-traumacast-pediatric-trauma-society-2019-2280.md)
- [VTE PPX in High Risk Trauma Patients: 2018 Pediatric Surgery Practice Gap #7](https://qa.library.globalcastmd.com/watch/vte-ppx-in-high-risk-trauma-patients-2018-pediatric-surgery-practice-gap-7-1452) — video · [machine version](https://qa.library.globalcastmd.com/watch/vte-ppx-in-high-risk-trauma-patients-2018-pediatric-surgery-practice-gap-7-1452.md)
- [JPS Journal Club: July 2019 Part 1](https://qa.library.globalcastmd.com/watch/jps-journal-club-july-2019-part-1-1577) — video · [machine version](https://qa.library.globalcastmd.com/watch/jps-journal-club-july-2019-part-1-1577.md)
- [JPS Journal Club: July 2019 Part 2](https://qa.library.globalcastmd.com/watch/jps-journal-club-july-2019-part-2-1592) — video · [machine version](https://qa.library.globalcastmd.com/watch/jps-journal-club-july-2019-part-2-1592.md)
- [JPS Journal Club: July 2019 Part 3](https://qa.library.globalcastmd.com/watch/jps-journal-club-july-2019-part-3-1606) — video · [machine version](https://qa.library.globalcastmd.com/watch/jps-journal-club-july-2019-part-3-1606.md)
- [A novel streamlined trauma response team training improves imaging efficiency for pediatric blunt abdominal trauma patients](https://qa.library.globalcastmd.com/article/a-novel-streamlined-trauma-response-team-training-improves-imaging-efficiency-fo-1151) — article · [machine version](https://qa.library.globalcastmd.com/article/a-novel-streamlined-trauma-response-team-training-improves-imaging-efficiency-fo-1151.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=0) Introduction and Importance of Pediatric Trauma (Ep 1)
- [1:25](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=85) Case Presentation and Initial Assessment Priorities (Ep 1)
- [3:47](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=227) Airway Management in Pediatric Trauma (Ep 1)
- [7:04](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=424) Circulation and Shock Management (Ep 1)
- [11:28](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=688) Neurological Assessment in Pediatric Trauma (Ep 1)
- [13:27](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=807) Imaging Guidelines and Conclusion (Ep 1)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- The priorities when evaluating a small child with multi-system trauma are the same as for an adult patient: airway, breathing, circulation (ABCs). — Rich Falcone (clinical) [Ep 1 · 2:44](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=164)
- Pediatric patients have more pliable chests so ribs don't necessarily break, but they can have a lot of pulmonary contusions and other injuries. — Rich Falcone (clinical) [Ep 1 · 3:58](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=238)
- Pediatric patients have a more mobile mediastinum that will shift more easily in response to tension pneumothorax compared to older patients. — Rich Falcone (clinical) [Ep 1 · 4:20](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=260)
- Airway management should follow a stepwise approach starting with simple maneuvers like jaw thrust before progressing to more invasive interventions. — Rich Falcone (clinical) [Ep 1 · 5:06](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=306)
- Pediatric patients have big tongues and big heads; when laid on a backboard, the large occiput flexes the head forward and can obstruct the airway. — Rich Falcone (clinical) [Ep 1 · 5:06](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=306)
- Some pediatric backboards have a cutout for the head or a bump to keep the torso higher and maintain ear-in-line-with-shoulder positioning. — Rich Falcone (clinical) [Ep 1 · 5:06](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=306)
- ATLS guidelines recommend needle cricothyroidotomy for patients under 10 years old and surgical cricothyroidotomy for patients over 10. — Rich Falcone (guideline) [Ep 1 · 6:02](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=362)
- Provider comfort level matters in cricothyroidotomy choice; saving a life with potential tracheal damage is better than death from inaction. — Rich Falcone (opinion) [Ep 1 · 6:02](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=362)
- Pediatric blood volume can be calculated as weight in kilograms times 80 mL. — Rich Falcone (clinical) [Ep 1 · 10:15](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=615)
- A 12 kg child's entire blood volume is approximately one liter; a 25 kg child has approximately 2 liters. — Rich Falcone (clinical) [Ep 1 · 10:15](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=615)
- Massive transfusion protocols have been proven to help, with more data in adults but also data supporting use in pediatrics. — Todd Ponsky (clinical) [Ep 1 · 10:57](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=657)
- Once a massive transfusion protocol is activated, blood products continue to arrive automatically until the protocol is stopped; providers must remember to deactivate it. — Todd Ponsky (clinical) [Ep 1 · 10:57](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=657)
- Thromboelastography (TEG) can guide transfusion management if readily available at the institution. — Todd Ponsky (clinical) [Ep 1 · 10:57](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=657)
- Glasgow Coma Scale can be assessed in nonverbal children; they should not automatically receive a low verbal score just because they cannot talk. — Rich Falcone (clinical) [Ep 1 · 12:09](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=729)
- For nonverbal children, if babbling or saying nonsense is normal for their age, they receive full verbal score; if irritable and crying, they get a 4; if moaning, a 2; if doing nothing, that is most concerning. — Rich Falcone (clinical) [Ep 1 · 12:09](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=729)
- A young child who does not cry in response to IV stick or IO placement, or who stops crying suddenly, is most concerning from a neurostatus perspective. — Rich Falcone (clinical) [Ep 1 · 12:09](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=729)
- Children have more diffuse brain injuries in general than adults. — Rich Falcone (clinical) [Ep 1 · 12:57](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=777)
- Child abuse is the most common cause of severe head injury in children less than 2 years old. — Rich Falcone (epidemiological) [Ep 1 · 12:57](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=777)
- Children are more at risk for head injury because of big heads, soft skulls, and tendency to fall on their heads. — Rich Falcone (clinical) [Ep 1 · 12:57](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=777)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Trauma and trauma-related injuries are the number one killer of pediatric patients. — Rod Gerardo summarizes what Dr. Rich Falcone said [Ep 1 · 0:08](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=8)
- MIST stands for mechanism of injury, injuries identified, signs and symptoms, and treatments. — Ellen Encisco summarizes what Dr. Rich Falcone said [Ep 1 · 1:40](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=100)
- Cricothyroidotomy is not a definitive airway; it buys time to get to the OR for formal tracheostomy. — Rod Gerardo summarizes what Dr. Rich Falcone said [Ep 1 · 6:57](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=417)
- For needle cricothyroidotomy, a 10 mL syringe with IV catheter can connect to an Ambu bag for ventilation. — Ellen Encisco summarizes what Dr. Rich Falcone said [Ep 1 · 7:04](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=424)
- Intraosseous (IO) access can be placed in the tibia, humeral head, or distal femur. — Ellen Encisco summarizes what Dr. Rich Falcone said [Ep 1 · 8:26](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=506)
- The old ATLS protocol was to give 20 cc/kg crystalloid bolus, assess response, give another 20 cc/kg, and only then use blood products. — Ellen Encisco summarizes what Dr. Rich Falcone said [Ep 1 · 8:54](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=534)
- Updated ATLS guidelines recommend one crystalloid bolus at 20 cc/kg, and if there is transient or no response, proceed directly to blood products at 10 cc/kg. — Ellen Encisco summarizes what Dr. Rich Falcone said [Ep 1 · 8:54](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=534)
- For a child to start showing signs of hemorrhagic shock, they would have to lose about 50% of their total blood volume. — Ellen Encisco summarizes what Dr. Rich Falcone said [Ep 1 · 10:07](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=607)
- Over 75% of pediatric trauma deaths are due to head injuries. — Rod Gerardo summarizes what Dr. Rich Falcone said [Ep 1 · 11:56](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=716)
- Validated algorithms exist to determine when head CT is not needed in pediatric trauma, with different criteria for children younger than 2 versus older than 2. — Rod Gerardo summarizes what Dr. Rich Falcone said [Ep 1 · 13:27](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=807)
- For children younger than 2, head CT may not be needed if the child is not acting different per parents, has no skull fracture, and meets other criteria. — Rod Gerardo summarizes what Dr. Rich Falcone said [Ep 1 · 13:27](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=807)
- For children older than 2, additional head CT decision criteria include history of vomiting and signs of basilar skull fracture. — Rod Gerardo summarizes what Dr. Rich Falcone said [Ep 1 · 13:27](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=807)
- A multi-institutional algorithm for blunt abdominal trauma uses criteria including abdominal pain, abdominal wall trauma/tenderness/distension, abnormal chest X-ray, AST greater than 200, and abnormal pancreatic enzymes. — Rod Gerardo summarizes what Dr. Rich Falcone said [Ep 1 · 13:27](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=807)
- If all blunt abdominal trauma algorithm criteria are negative (approximately 35% of patients), the risk of intraabdominal injury is very low at 0.6%, with 0.0% requiring intervention. — Rod Gerardo summarizes what Dr. Rich Falcone said [Ep 1 · 13:27](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=807)
- Having one positive criterion on the blunt abdominal trauma algorithm does not mandate CT but increases risk; multiple positive criteria further increase risk. — Rod Gerardo summarizes what Dr. Rich Falcone said [Ep 1 · 13:27](https://qa.library.globalcastmd.com/watch/atls-2021-pediatric-surgery-update-4549?t=807)

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