Pediatric Abdominal Trauma

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