Trauma
PED-27
Diagnosis
Initial management of trauma, follow ATLS
Set-up prior to patient arrival to OR
Assemble team and assign roles
Estimate weight and prepare emergency drugs
Gather equipment:
- Airway supplies
- Line placement and monitoring devices
- Fluid warmer/rapid infusion device
- Code cart with programmed defibrillator
Type and cross blood products. Activate massive transfusion protocol if indicated
- Call Blood Bank
On patient arrival to OR
Maintain c-spine precautions for transport
Secure/confirm airway (often aspiration risk, unstable c-spine)
Ensure adequate ventilation (maintain PIP < 20 cm H20)
Obtain/confirm large-bore IV access (central or intraosseous if peripheral unsuccessful)
Assess hemodynamic stability. Pre-induction fluid bolus recommended if hypovolemic
20 mL/kg LR or NS (repeat x 2) and/or 10 mL/kg RBCs or 20 mL/kg whole blood.
- Call Blood Bank
- If needed, go to MASSIVE HEMORRHAGE
Arterial and central venous line placement if indicated
Maintain normothermia
Monitor and treat associated conditions
- Anemia, coagulopathy, acidosis, electrolyte derangements
Continuously assess for undiagnosed secondary and/or developing injuries, blood loss
Consider TXA 10-30 mg/kg IV bolus then 5-10 mg/kg/h IV infusion within 3 hours
Crisis Management (If Severe)
Notify surgeon, call for help and code cart
Call for Transesophageal Echocardiography
Start chest compressions
Give epinephrine 10 MICROgrams/kg IV/IO
If cardiac arrest, go to CARDIAC ARREST
Consider ECMO
Drugs
| LR or NS | 20 mL/kg, repeat x 2 |
|---|---|
| RBCs | 10 mL/kg |
| Whole blood | 20 mL/kg |
| TXA | Bolus 10-30 mg/kg IV |
| TXA | Then 5-10 mg/kg/h IV infusion within 3 hours |