Pediatric emergency medicine trisk 0152 0152
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with fully cross-matched, warmed blood. In the face of a transient or absent response
to a rapid crystalloid infusion, type-specific, or type O–negative blood can be given as
a whole-blood transfusion. Fluid and blood are given rapidly enough to maintain
stable VS and adequate urine output. Vasopressors, steroids, and sodium bicarbonate
do not play a role in the initial treatment of hemorrhagic shock. Currently, there is no
universally accepted massive transfusion protocol for pediatric trauma victims with
most protocols institution-specific.
TABLE 7.6
IV ESCALATION PLAN
• Establish 2 large bore IVs and begin NS fluid resuscitation within the first 15
minutes
• Implement IV escalation pathway considering individual patient
• Ill patients require a second access at a peripheral site
Minutes
Access procedure
0–5
First peripheral IV with largest gauge possible
Consider IO immediately in severely ill patients
Second peripheral attempt
Consider US-guided peripheral IV
Consider EJ (US guided)
Notify vascular access specialist (IV team)
5–10
10–15
If still no access
EZ-IO
EJ (consider US guided)
Central line (consider US guided) or
Call intensivist or surgeons to assist at bedside, if available
SECONDARY SURVEY
The goal of the secondary survey is to identify the definitive cause of the respiratory,
circulatory, and/or neurologic abnormalities treated during the primary survey. In the
case of trauma patients, the secondary survey reveals any injuries not found and/or
addressed in the primary survey.
During the secondary survey, a systematic head-to-toe examination is performed
with special attention to specific organ systems associated with the patient’s chief
complaint and personal risk factors. Elements of the secondary survey may be
skipped or deferred, depending on the clinical situation, and patient stability ( Table
7.7 ).
