Emergency Medicine: Open Access
Open Access

Pediatric Trauma Care Management

Veena Priyadarshini S^{* *}Correspondence: Veena Priyadarshini S, School of Life Sciences, B.S. Abdur Rahaman Crescent Institute of Science and Technology, Chennai, Tamil Nadu, India, Email:

Author info »

Commentary

The global focus on lowering childhood mortality and achieving the Sustainable Development Goals (SDGs) has resulted in considerable decreases in childhood deaths worldwide. However, there has been an epidemiologic change, with relative rises in mortality from injuries and decreases in deaths from malnutrition and infections like pneumonia and diarrheal illnesses. Trauma is a leading cause of death and disability around the world. Low- and middle-income nations account for nearly all the 5.8 million deaths that occur each year (LMICs). Children account for over one million of these deaths. Road traffic accidents (RTAs), falls, burns, drowning, and poisoning are the top five etiologies for unintentional injuries, according to the World Health Organization (WHO). Children are also injured or murdered in conflict zones, natural disasters, and because of child abuse. Because of the scarcity of resources, trauma prevention and careful resource allocation and use are essential in the care of injured children. Injury is the greatest cause of death in children aged 1 to 14, with head traumas accounting for 38% of all pediatric injuries. While the construction of integrated and regionalized trauma systems has improved access and survival for all trauma victims, pediatric trauma research has become a major focus in recent years. Quality care is built on infrastructure, care methods, and outcome metrics.

Pediatric transport medicine has advanced in tandem with regionalization attempts during the last two to three decades. Identification of very unwell infants and early stabilization allow for speedy pre-hospital transport to specialist hospitals capable of definitive interventions during the "golden hour." The "golden hour" concept came from research by Cowley et al. in the early 1970s, which showed that delivering patients to trauma centers quickly improved results. Recent research suggests that the "golden hour" notion in paediatric trauma has been misapplied. This is due to the emphasis on getting patients from outlying hospitals to tertiary trauma centers as soon as feasible. Early vital therapies, which can be started in local emergency departments, may be delayed because of this. Patients who had greater monitoring during transit had shorter lengths of stay and reduced incidence of multi organ dysfunction, according to the IMPACT prospective randomized trial. Children cry for a variety of reasons, and it's crucial to figure out if they're in discomfort. The injured child who appears to be in pain, as evident as it may seem, is most certainly in pain. Before beginning treatment, the trauma physician must identify the severity, etiology, and nature of the pain. To measure pain in children, a variety of pain assessment instruments are available. The Alder Hey Triage Pain Score (AHTPS) was created and validated for children aged 0 to 16 at triage in an emergency department. If the youngster is apneic or has a low respiratory effort, they will require assisted ventilation. Bag-valve-mask (BVM) ventilation for a short length of time is equally effective as ETT ventilation when done correctly, and it may be safer. In an urban pre-hospital context, a controlled trial of BVM versus ETT ventilation demonstrated no significant difference in survival or the rate of reaching a favorable neurological outcome between the BVM and the ETT groups.

In the past, pain has been undertreated in patients who go to the emergency room. This issue may be even more prevalent in young pre wounded children than in older children. Many doctors are concerned that using painkillers will disguise the symptoms of a developing injury. The use of opioids did not result in a substantial increase in treatment errors in patients presenting to the ED with abdominal pain, according to a new meta-analysis. There was a non-significant absolute decrease in management errors in the three paediatric trials that were included. Hypothermia should be considered a possibility for all victims of major trauma. Hypothermia is more common in children than in adults. Arrhythmias, coagulation problems, and acidosis can all be caused by hypothermia. In trauma victims, the latter two, coupled with hypothermia, make up "the trinity of death." The primary survey should include an initial core temperature measurement (oral, rectal, or bladder). Accidents, injuries, physical abuse, or hospitalization can leave a permanent impression on the psyche of some youngsters. While some people can manage and move on from their experiences, others, including their families, may require psychosocial help and intervention. Medical facilities that deal with traumatized children should have a multidisciplinary team of social workers, psychiatrists, psychologists, and other professionals on hand to assist patients and their families in dealing with the aftermath of a traumatic experience.