Pediatric Abdominal Trauma

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The podcast episode highlights some crucial points about pediatric blunt abdominal trauma and how it differs from trauma in adults, particularly in terms of diagnosis and management.

Key Takeaways:

1. Risk Factors in Children:
   • Children are more vulnerable to serious abdominal injuries (liver, spleen, kidneys) due to factors like thinner abdominal walls, minimal rib coverage, and smaller organs.
   • The spleen is the most commonly injured organ, followed by the kidneys.
   • These injuries can often go unrecognized but can be fatal if not treated properly.
2. Diagnostic Tools:
   • FAST (Focused Assessment with Sonography in Trauma): While this ultrasound is useful for detecting free fluid in the abdomen, it’s less reliable in children. A negative FAST doesn’t necessarily rule out intra-abdominal injury.
   • CT Scans: A more reliable option for detecting injuries like grade IV liver lacerations.
   • Laboratory Tests: Blood work (CBC, CMP, PT, PTT, INR, Amylase, and Lipase) can help assess the severity of the injury and monitor for complications like hemorrhage or organ dysfunction.
   • Type and Screen: Important for determining blood type in case a transfusion is needed.
3. Management:
   • Fluid resuscitation (e.g., 20ml/kg of isotonic fluids) to address any signs of shock or dehydration.
   • Monitoring: Regular assessments through serial abdominal exams and lab draws are essential to track the patient’s progress.
   • Invasive Interventions:
     • Operative Intervention: Surgery may be necessary for severe injuries or if there’s ongoing bleeding or organ damage.
     • Angioembolization: Can be used to control bleeding, especially in cases of splenic or hepatic trauma.
     • Ureteral Stenting: If there’s involvement of the urinary tract, stenting may be needed to maintain urine flow and prevent further injury.
4. Post-Injury Care:
   • Activity Restriction:
     • For injuries graded 2 or higher, activity restrictions are typically enforced for about two weeks to allow healing.
     • The child must follow up in the clinic to be cleared for sports or physical activity.
   • Hypertension (HTN) Management: If hypertension arises from the injury, it should be treated outpatient after discharge, as some patients may lack follow-up care post-discharge.
5. Indications for Escalation:
   • Warning Signs: Changes in hemodynamic stability, fever, tachycardia, tachypnea, or altered mental status should prompt immediate reevaluation and escalation of care.

Click the link below for images discussed in the podcast:
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References:

Kline-Tilford, A. M., & Haut, C. (2020). Cases in pediatric acute care: Strengthening clinical decision making. Wiley-Blackwell.

Additional Resources:

PICU Essentials on the App Store (apple.com)

PICU Essentials - Apps on Google Play