4. Pediatric Trauma Assessment

4.1. What are the Features Specific to Pediatric Patients?

Pediatric Differences in Emergency Settings

There are specific differences between children and adults to be considered in emergency settings.

Children are at a disproportionately increased risk for different reasons:

  • High respiratory rate: Children are more vulnerable to aerosolized agents, chemicals, carbon monoxide, etc.
  • Less fluid reserve: Children are more susceptible to dehydration.
  • Less circulating volume: Smaller amounts of blood loss can lead to hypovolemic shock.
  • Developmental vulnerabilities: Infants and toddlers are less able to escape a disaster; they cannot follow directions or make immediate choices.

Anatomic and Physiologic Differences

  • Prominent occiput: Flexion of the neck on spine boards.
  • Increased amount of secretions: May require more suctioning.
  • Infants <3 months are obligate nose breathers: Susceptible to anatomic obstruction and infections.
  • Relatively larger tongue compared with mandible: May make use of bagvalve-mask or intubation difficult.
  • Large adenoids: Bleeding is common, especially with nasal intubations.
  • Flexible omega-shaped epiglottis, with anterior location: Intubation and visualization of the larynx require lifting the epiglottis with a straight blade.
  • Smaller diameter of the subglottic region until about age 8; therefore, noncuffed endotracheal tubes (ETTs) are used until ~8 years of age to avoid cuff trauma.