A/Prof Brian Burn's talk from SWAN XXIV

1. Pitfalls in Paediatric
Resuscitation
Brian Burns
@HawkmoonHEMS

2. www.resus.me/swan24

3. AXIOMATIC

4. Kids are little adults

5. Severe TBI and haemorrhage
TOP
KILLERS
in
TRAUMA

6. Severe TBI
EARLY hypotension(PH/ED): SBP <5%
centile = very bad
Hypoxia, hypercarbia = bad

8. Errors of Omission
Cognitive overload

10. high performance
consistency
familiarity

11. Haemorrhage
DCR
Early products- ideal = whole blood
Haemostatic resuscitation
Minimising crystalloid
Avoid over-resuscitation
Avoid supernormal MAP
Rapid haemorrhage control

12. ATC
Shock Hypoperfusion

13. Coagulopathy?
Plasma-based lab tests
PT,aPTT, INR, fibrinogen, plt
poor clinical correlation
retrospective

15. Predefined MTP

16. TXA
< 3 hrs from injury
Who? : ATC/high risk ATC
15mg/Kg over 1 hr then 2mg/kg/hr over 8 hours

17. Transfusions
volume overload
electrolyte disturbance
dilutional coagulopathy if not balanced
haemolysis
TRALI
MOF
PREDEFINED MTP=less MOF, infection, ventilation, mortality

18. SHOCK
Paediatric age-adjusted SI
Lactate >4
NARROW pulse pressure

21. Interventions
SAME indications as adults
Do it!

22. Resuscitative thoracotomy
Penetrating TCA <10min loss SOL or loss SOL
in ED
Blunt TCA without SOL in ED unsalvageable

24. Logistics

25. Analgesia
Avoid oligoanalgesia
Subdissociative ketamine
Intranasal fentanyl

26. Kids are not little
adults

27. • larger heads
• less fat
• more exposed solid organs
• pliable skeleton=
• force transmission

28. Injury Pattern
MVC/Pedestrian
Falls
Low penetrating

29. Physiology
hypovolaemia masked by reserve and
compensation until >20% BV loss
high BMR= high O2 consumption
higher BSA to weight= hypothermia

30. Psychosocial
Behaviour regresses by 5 years
Parents in the resus room

31. Radiology
Focused CT. ALARA principle
eFAST ?

32. Non-operative critical care
Close observation v surgery

33. Trauma deaths
process
safeguard the future performance of team +
system

34. Kids should sometimes be treated like little
adults and sometimes they should not
Knowing when is the key