37 - Trauma and mass casualties

Abstract

Traumatic injuries are the most common cause of death in the United States in children older than 1 year of age. Pediatric patients with traumatic injuries can vary in complexity ranging from an isolated foot fracture to a life-threatening traumatic brain injury requiring emergent surgery. Strategies of advanced trauma life support (ATLS) and pediatric advanced life support (PALS) should be utilized in the perioperative setting to effectively care for pediatric trauma patients. These strategies include recognition of cardiopulmonary disorders, volume resuscitation, and prevention of additional injuries including those to the cervical spine. Trauma patients may present hemodynamically unstable and with unclear circumstances. Patient information may be limited and missing important details such as past medical history, past surgical history, and drug allergies. Although the general principles of resuscitation for pediatric trauma patients are similar to those used for adults, effective management of the pediatric trauma patient also requires an appreciation of the anatomical, physiological, developmental, and emotional characteristics that differentiate children from adults. The management of pediatric trauma patients typically involves a multidisciplinary team. Anesthesiologists contribute an important role within this team to deliver effective care to the pediatric trauma patient, provide the initial evaluation and resuscitation of the pediatric trauma patient, and continue this process throughout the perioperative period. Anesthesiologists, surgeons, and other personnel must work in concert as a synchronized team when managing children with traumatic injuries.