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.
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Work-up and Treatment
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Updates
9 items
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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Trauma remains the leading cause of pediatric mortality, with head injuries accounting for over 75% of deaths.[e4549-c1,e4549-c20] Initial assessment follows standard ATLS priorities—airway, breathing, circulation—but anatomic differences matter: children's pliable chests permit significant pulmonary contusion without rib fracture, and mobile mediastina increase tension pneumothorax risk.[e4549-c4,e4549-c5,e4549-c6] Airway management begins with jaw thrust; backboards require occipital cutouts to prevent flexion obstruction.[e4549-c7,e4549-c8] For failed peripheral access, intraosseous placement is standard; current ATLS guidelines recommend one 20 mL/kg crystalloid bolus followed by immediate blood (10 mL/kg) if response is inadequate.[e4549-c12,e4549-c14] Children compensate well—hemorrhagic shock signs appear only after ~50% blood volume loss. Validated decision rules safely reduce head CT use in low-risk patients, while a multi-institutional algorithm identifies blunt abdominal trauma patients at very low risk (0.6%) requiring no imaging.[e4549-c27,e4549-c28,e4549-c29] VTE prophylaxis stratifies by bleeding risk: low-risk patients receive SCDs plus LMWH; high-risk patients use SCDs alone until ambulatory, with ultrasound screening on ICU day seven.[e1452-c1,e1452-c2] Child abuse causes most severe head injuries under age two and demands systematic evaluation via institutional protocols, multidisciplinary teams, and mandatory reporting regardless of transfer status.[e4549-c25,e1606-c1,e1606-c7,e1606-c8]
- Pediatric chest compliance permits severe pulmonary contusion without rib fracture; mobile mediastinum increases tension pneumothorax susceptibility requiring high clinical suspicion.[e4549-c5,e4549-c6]
- Current ATLS: one 20 mL/kg crystalloid bolus, then immediate blood (10 mL/kg) for inadequate response. Children tolerate 50% volume loss before shock signs appear.[e4549-c14,e4549-c15]
- Validated algorithms safely eliminate head CT in low-risk patients and identify blunt abdominal trauma patients (0.6% injury risk) requiring no imaging.[e4549-c27,e4549-c28,e4549-c29]
- VTE prophylaxis: low bleeding risk gets SCDs+LMWH; high risk uses SCDs alone until ambulatory, then ultrasound on ICU day seven. LMWH withheld in high-risk cohort.[e1452-c1,e1452-c2,e1452-c3]
- Child abuse causes most severe head injuries <2 years. Institutional protocols with automatic workups for sentinel injuries eliminate subjective bias; transfer does not waive mandatory reporting.[e4549-c25,e1606-c11,e1606-c8]
For patients & families
Trauma remains the leading cause of death in children, and physicians have developed careful approaches to help injured kids. When a child arrives after an accident, doctors follow the same priorities as for adults—checking airway, breathing, and circulation first. Children's bodies are different: their flexible ribs may not break even when lungs are badly bruised, and their large heads make airway positioning especially important. If a child needs fluids quickly, doctors now give one dose of IV fluid and then move to blood products if the child doesn't improve, because children can lose half their blood volume before showing clear shock signs. Head injuries cause more than three-quarters of trauma deaths in children, and doctors use special scoring systems that account for young children who can't yet talk. For car crashes, proper restraint makes an enormous difference—children who weren't buckled correctly had much worse injuries, especially to the head and neck. Physicians also discussed firearm injuries as a public health crisis and child abuse as a form of trauma that requires the same systematic hospital response as any serious injury.
Trauma remains the leading cause of death in children, and physicians have developed careful approaches to help injured kids. When a child arrives after an accident, doctors follow the same priorities as for adults—checking airway, breathing, and circulation first. Children's bodies are different: their flexible ribs may not break even when lungs are badly bruised, and their large heads make airway positioning especially important. If a child needs fluids quickly, doctors now give one dose of IV fluid and then move to blood products if the child doesn't improve, because children can lose half their blood volume before showing clear shock signs. Head injuries cause more than three-quarters of trauma deaths in children, and doctors use special scoring systems that account for young children who can't yet talk. For car crashes, proper restraint makes an enormous difference—children who weren't buckled correctly had much worse injuries, especially to the head and neck. Physicians also discussed firearm injuries as a public health crisis and child abuse as a form of trauma that requires the same systematic hospital response as any serious injury.
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ATLS 2021 Pediatric Surgery Update
Trauma and trauma-related injuries are still the number one killer of pediatric patients
Host summaryRod Gerardo summarizes what Dr. Rich Falcone said — not the host's own clinical position0:08 ↗
Rich Falcone is a pediatric surgeon and the director of trauma services at Cincinnati Children's Hospital Medical Center
Host summaryRich Falcone summarizing a resource — not the host's own clinical position0:40 ↗
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
clinicalRich Falcone2:44 ↗
Pediatric patients have more pliable chests so the ribs don't necessarily break, but they can have a lot of pulmonary contusions and other injuries
clinicalRich Falcone3:58 ↗
Pediatric patients are more susceptible to tension pneumothorax because their mediastinum is more mobile and will shift more easily in response to that tension
clinicalRich Falcone4:20 ↗
For pediatric airway management, start with simple maneuvers like a jaw thrust because children have big tongues and big heads
clinicalRich Falcone5:06 ↗
When children are laid on a backboard, their large occiput causes head flexion which can obstruct the airway; pediatric backboards have a cutout for the head or a bump to keep the torso higher and maintain ear in line with shoulder
clinicalRich Falcone5:06 ↗
Needle cricothyroidotomy is recommended for children under 10 years old, while surgical cricothyroidotomy is for children over 10, according to ATLS guidelines
guidelineRich Falcone6:13 ↗
A cricothyroidotomy is not a definitive airway but buys time to get to the OR to do a 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 be used and connects to the Ambu bag
Host summaryEllen Encisco summarizes what Dr. Rich Falcone said — not the host's own clinical position7:04 ↗
When peripheral IV access cannot be obtained, the next step is intraosseous (IO) access
Host summaryRod Gerardo summarizes what Dr. Rich Falcone said — not the host's own clinical position8:14 ↗
An IO can be placed in the tibia, the humeral head, or in the distal femur
Host summaryEllen Encisco summarizes what Dr. Rich Falcone said — not the host's own clinical position8:28 ↗
The new ATLS guideline is to give one 20 cc/kg bolus of crystalloid, and if there is transient or no response, go right to blood (10 cc/kg) as the next step
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 is calculated as weight in kilos times 80 mLs
clinicalRich Falcone10:15 ↗
A 12 kg child's entire blood volume is about a liter, and a 25 kg child has about 2 liters
clinicalRich Falcone10:15 ↗
Massive transfusion protocols have been proven to help, with more data in the adult world but also data in pediatrics
clinicalTodd Ponsky10:57 ↗
Once blood transfusion starts, it is advisable to keep track of TEG (thromboelastography) if the institution has it readily available
opinionTodd Ponsky11:28 ↗
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 performed in a nonverbal child; if they cannot talk normally, they do not lose points for the verbal component
clinicalRich Falcone12:09 ↗
For verbal GCS scoring in nonverbal children: if they babble and say nonsense normally, they get full score; if irritable and crying, they get a 4; if just moaning, a 2; if doing nothing, that is most concerning
clinicalRich Falcone12:09 ↗
A child who does not respond to IV stick or IO placement, or a child who is crying a lot and then suddenly stops crying, is most concerning from a neurostatus perspective in the trauma bay
opinionRich Falcone12:09 ↗
Kids have more diffuse brain injuries in general than the adult population
clinicalRich Falcone12:57 ↗
Child abuse is the most common cause of severe head injury in kids less than 2 years old
epidemiologicalRich Falcone12:57 ↗
Kids are more at risk for head injury because of big heads, soft skulls, and they often fall on their head
clinicalRich Falcone12:57 ↗
There are validated clinical decision rules for when not to obtain head CT in pediatric trauma patients, with different criteria for children less than 2 years versus older than 2 years
Host summaryRod Gerardo summarizes what Dr. Rich Falcone said — not the host's own clinical position13:27 ↗
For blunt abdominal trauma, a multi-institutional algorithm identifies patients at very low risk (0.6%) of intraabdominal injury if they answer no to: abdominal pain, abdominal wall trauma/tenderness/distension, abnormal chest X-ray, AST greater than 200, or abnormal pancreatic enzymes
Host summaryRod Gerardo summarizes what Dr. Rich Falcone said — not the host's own clinical position13:27 ↗
Approximately 35% of blunt abdominal trauma patients meet low-risk criteria (all negative findings), and 0.0% of those required intraabdominal injury intervention
Host summaryRod Gerardo summarizes what Dr. Rich Falcone said — not the host's own clinical position13:27 ↗
JPS Journal Club: July 2019 Part 2
Finley et al. out of Rutgers examined injury severity scores for pediatric patients who were either restrained or unrestrained/improperly restrained in motor vehicle collisions.
Host summaryRae Hanke summarizing a resource — not the host's own clinical position0:29 ↗
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