Collection
Early Assessment and Management of Trauma
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
ATLS guidelines recommend needle cricothyroidotomy for patients under 10 years old and surgical cricothyroidotomy for patients over 10. — Rich Falcone, ATLS 2021 Pediatric Surgery Update · 6:02
ATLS 2021 Pediatric Surgery Update
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In this episode, we hear important 2021 ATLS updates for the care of pediatric trauma patients from Dr. Rich Falcone, Director of Trauma Services at Cincinnati Children's Hospital Medical Center. Hosted by Rod Gerardo, Ellen Encisco, and To
podcast16:05 · Oct 2021
Update Course Rewind: Cervical Spine Clearance 2019
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Cervical spine clearance in the pediatric trauma patient can be difficult - especially in those patients less than 3 years old. That's why Dr. Meera Kotagal reviewed the C-spine literature and recommendations during our 2019 Pediatric Surge
podcast · May 2021
Update Course Rewind: TEG 2019
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TEG, also known as thromboelastography is gaining popularity. So Dr. Elizabeth Beierle talked about the basics at our 2019 Pediatric Surgery Update Course. Mark your calendars for the next one on August 27, 2021.
podcast · May 2021
Guest Podcast from EAST Traumacast: Pediatric Trauma Society 2019
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This is a guest podcast and collaboration with the EAST Traumacast, which highlights the Sixth Annual Pediatric Trauma Society Meeting in November 2019. Dr. Ian Mitchell from Children's Hospital San Antonio, Dr. Alexander Gibbons from Akron
podcast · Dec 2020
VTE PPX in High Risk Trauma Patients: 2018 Pediatric Surgery Practice Gap #7
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Drs Todd Ponsky, Alex Casar, Alex Gibbons and Rae Hanke review Practice Gap #7 from 2018, as identified by APSA's Professional Development Committee.
video · Jun 2019
JPS Journal Club: July 2019 Part 1
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The first of three videos discussing the trauma-heavy July issue of the Journal of Pediatric Surgery. In this episode, we discuss the American Pediatric Surgical Association Position Statement on firearm injuries, which is unfortunately tim
video · Aug 2019
JPS Journal Club: July 2019 Part 2
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The second of three videos discussing the trauma-heavy July issue of the Journal of Pediatric Surgery. In this episode, we discuss an article showing injury patterns in children who are not wearing their seatbelt properly during motor vehic
video · Aug 2019
JPS Journal Club: July 2019 Part 3
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The last of three videos discussing the trauma-heavy July issue of the Journal of Pediatric Surgery. In this episode, we discuss the position statement from @American Pediatric Surgical Association pertaining to child absue. Find the articl
video · Aug 2019
A novel streamlined trauma response team training improves imaging efficiency for pediatric blunt abdominal trauma patients
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AbstractBackground/purposeThe morbidity and mortality of children with traumatic injuries are directly related to the time to definitive management of their injuries. Imaging studies are used in the trauma evaluation to determine the injury
article · Feb 2019
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Expert statements from the recordings in this collection.
ATLS 2021 Pediatric Surgery Update
Trauma and trauma-related injuries are the number one killer of pediatric patients.
Host summaryRod Gerardo summarizes what Dr. Rich Falcone said — not the host's own clinical position0:08
MIST stands for mechanism of injury, injuries identified, signs and symptoms, and treatments.
Host summaryEllen Encisco summarizes what Dr. Rich Falcone said — not the host's own clinical position1:40
The priorities when evaluating a small child with multi-system trauma are the same as for an adult patient: airway, breathing, circulation (ABCs).
Rich Falcone2:44
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 Falcone3:58
Pediatric patients have a more mobile mediastinum that will shift more easily in response to tension pneumothorax compared to older patients.
Rich Falcone4:20
Airway management should follow a stepwise approach starting with simple maneuvers like jaw thrust before progressing to more invasive interventions.
Rich Falcone5:06
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 Falcone5:06
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 Falcone5:06
ATLS guidelines recommend needle cricothyroidotomy for patients under 10 years old and surgical cricothyroidotomy for patients over 10.
Provider comfort level matters in cricothyroidotomy choice; saving a life with potential tracheal damage is better than death from inaction.
Cricothyroidotomy is not a definitive airway; it buys time to get to the OR for formal tracheostomy.
Host summaryRod Gerardo summarizes what Dr. Rich Falcone said — not the host's own clinical position6:57
For needle cricothyroidotomy, a 10 mL syringe with IV catheter can connect to an Ambu bag for ventilation.
Host summaryEllen Encisco summarizes what Dr. Rich Falcone said — not the host's own clinical position7:04
Intraosseous (IO) access can be placed in the tibia, humeral head, or distal femur.
Host summaryEllen Encisco summarizes what Dr. Rich Falcone said — not the host's own clinical position8:26
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.
Host summaryEllen Encisco summarizes what Dr. Rich Falcone said — not the host's own clinical position8:54
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.
Host summaryEllen Encisco summarizes what Dr. Rich Falcone said — not the host's own clinical position8:54
For a child to start showing signs of hemorrhagic shock, they would have to lose about 50% of their total blood volume.
Host summaryEllen Encisco summarizes what Dr. Rich Falcone said — not the host's own clinical position10:07
Pediatric blood volume can be calculated as weight in kilograms times 80 mL.
Rich Falcone10:15
A 12 kg child's entire blood volume is approximately one liter; a 25 kg child has approximately 2 liters.
Rich Falcone10:15
Massive transfusion protocols have been proven to help, with more data in adults but also data supporting use in pediatrics.
Todd Ponsky10:57
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 Ponsky10:57
Thromboelastography (TEG) can guide transfusion management if readily available at the institution.
Todd Ponsky10:57
Over 75% of pediatric trauma deaths are due to head injuries.
Host summaryRod Gerardo summarizes what Dr. Rich Falcone said — not the host's own clinical position11:56
Glasgow Coma Scale can be assessed in nonverbal children; they should not automatically receive a low verbal score just because they cannot talk.
Rich Falcone12:09
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 Falcone12:09
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 Falcone12:09
Children have more diffuse brain injuries in general than adults.
Rich Falcone12:57
Child abuse is the most common cause of severe head injury in children less than 2 years old.
Rich Falcone12:57
Children are more at risk for head injury because of big heads, soft skulls, and tendency to fall on their heads.
Rich Falcone12:57
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.
Host summaryRod Gerardo summarizes what Dr. Rich Falcone said — not the host's own clinical position13:27
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.
Host summaryRod Gerardo summarizes what Dr. Rich Falcone said — not the host's own clinical position13:27