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Trauma management: Approach to the unstable child

Authors
Lois K Lee, MD, MPH
Gary R Fleisher, MD
Section Editor
Richard G Bachur, MD
Deputy Editor
James F Wiley, II, MD, MPH

INTRODUCTION

In the United States, over 12,000 children and adolescents die annually of unintentional and intentional injuries, making trauma the leading cause of death for this population [1]. Injury and poisoning is also the leading cause of emergency department (ED) visits, accounting for over 7 million ED visits in 2010, which is over one quarter of the 25.5 million ED visits for children less than 18 years of age [2].

Blunt injury accounts for approximately 90 percent of all pediatric trauma. When blunt force is applied to a child's small body, multisystem trauma occurs frequently. Although the majority of injuries are mild to moderate in severity, the clinician caring for children should be prepared to rapidly evaluate and manage those patients with serious and life threatening trauma. In addition, children have differing anatomy and physiology from adults that require specific attention during advanced trauma care. (See "Trauma management: Unique pediatric considerations".)

The initial approach to the management of the unstable child with major traumatic injuries is presented here. The approach to the initially stable child with traumatic injury and the classification of trauma in the injured child are discussed separately. (See "Approach to the initially stable child with blunt or penetrating injury" and "Classification of trauma in children".)

OVERVIEW

A standardized approach to the initial management of trauma patients has been disseminated by the American College of Surgeons through the Advanced Trauma Life Support (ATLS) program (figure 1 and table 1). The ATLS protocols are based on the concept of the Trimodal Death Distribution [3]:

The first peak of death occurs in the seconds to minutes immediately after injury and only prevention can impact this mortality.

                                                

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Literature review current through: Nov 2016. | This topic last updated: Tue Oct 25 00:00:00 GMT 2016.
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References
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