Pediatric emergency medicine trisk 3577 3577
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Early airway management should be considered for patients with facial and
neck burns, including from ingested caustic substances. For circumferential burns,
an escharotomy may be indicated which involves a vertical incision from the chin
to the superior aspect of the sternal notch. This should only be performed by an
experienced provider familiar with pediatric neck anatomy (see Chapter 104
Burns ).
In blunt trauma, progressive onset pain, irritability, and signs of cord
compression may suggest a spinal (usually venous) epidural hematoma. Rapid
assessment by CT or MRI, followed by surgical intervention, will help ensure
optimal outcome. Clinically unstable patients should be considered for emergent
operative intervention.
Clinical Indications for Discharge or Admission
The patient can be discharged if they do not have a significant injury, are
hemodynamically stable, without any airway compromise, able to tolerate oral
intake to maintain their hydration, and no indication or risk of abusive trauma or
neglect is present. Otherwise, admission is indicated.
CERVICAL SPINE TRAUMA
Goals of Treatment
The goals are to identify cervical spine injury and prevent progression of
secondary injury by applying the principles of spine immobilization and acute
trauma resuscitation to maintain adequate ventilation, oxygenation, and
hemodynamic status.
CLINICAL PEARLS AND PITFALLS
Cervical spine injuries are uncommon in children but account for the
majority of vertebral injuries in children.
Younger children tend to have higher proportion of upper cervical spine
injuries (C1–C3) due to the higher fulcrum of the immature spine,
dislocations instead of fractures, and spinal cord injury without
radiographic abnormality (SCIWORA).
Children with congenital spine abnormalities, osseous weakness, or
ligamentous instability are at increased risk for spinal injury.
Airway management should be accomplished with simultaneous
stabilization of the cervical spine.
