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  • Injury is the leading cause of death of children in the United States.
  • Children have physiologic and psychologic responses to trauma that are different from those seen in adults.
  • The airway is secured while concomitantly stabilizing the neck. The jaw thrust maneuver is used to open the airway and the oropharynx is cleared of debris and secretions.
  • Orotracheal intubation is the most reliable means of securing an airway. An uncuffed tube should be used in children <8 years of age.
  • Hypovolemic shock is caused by blood loss, which makes up 8% to 9% of the body weight of a child. Determining the extent of volume depletion and shock is difficult in children and multiple parameters must be used.
  • Vascular access is difficult under the best of circumstances and can be a reason for delay in transport of a critically ill child. Attempt vascular access en route to avoid prolonged stay at the scene. Intraosseous infusion should be used as a quick access for crystalloid infusion if attempts at intravenous cannulation are unsuccessful after 90 seconds.
  • For shock, the initial resuscitative fluid is isotonic crystalloid solution, such as normal saline or Ringer's lactate. Give an initial infusion of 20 mL/kg as rapidly as possible.
  • Urinary output may help assess perfusion and intravascular status. Insert a Foley catheter and monitor urinary output as follows: 1 mL/kg/h for children >1 year of age and 2 mL/kg/h for children <1 year of age.
  • Unique characteristics of the pediatric cervical spine predispose it to ligamentous disruption and dislocation injuries without radiographic evidence of bone injury.


Injury is the leading cause of death in children in the United States and causes more deaths than all other causes combined.1 In 2004, trauma accounted for 59.5% of all deaths in children younger than 18 years and those caused by injuries, intentional or unintentional, account for more years of potential life lost than do deaths attributable to sudden infant death syndrome, cancer, and infectious diseases combined.2 Overall, mortality from pediatric trauma occurs at one-third of the rate of adult trauma deaths, pediatric case–fatality rates are higher when compared with adults who have similar injuries. Eighty percent of their trauma deaths occur either at the scene or prior to admission.


Mortality data alone does not reveal the profound impact of trauma. Each year, 20% of American children receive medical care for an injury. For children <14 years of age, injuries are the leading cause of visits to emergency departments (EDs), numbering 7.9 million, and the second leading cause of hospitalization, accounting for >200 000 admissions. The health care costs for injury are staggering. Unintentional injuries resulted in an estimated $14 billion in lifetime medical spending, $1 billion in other resource costs, and $66 billion in present and future work losses.3 Even minor injuries can have lasting effects causing functional impairment or subtle cognitive or behavioral deficits years after the acute traumatic event. Therefore, physical, emotional, and psychologic needs of the child and family must be considered.


The blunt trauma is the predominant mechanism in children, with only 10% to 20% suffering a penetrating injury. Motor vehicle crashes (MVCs) account for as ...

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