Resuscitation

Resuscitation

All children initially receive high-flow oxygen, preferably via - a non-rebreathe mask; this can be stopped if there is cardio - respiratory stability after a period of observation. Intubation and ventilation are required if oxygenation is inadequate or if there is a low GCS, combative behaviour, an inability to cooperate, severe burns, prolonged seizures or imminent oper - ative intervention. Ideally , seriously injured children require two large well-secured cannulae. Alongside the antecubital fossa, other suitable veins include the long saphenous a t the ankle, the femoral, the external jugular and, in neonates, scalp veins. If intravenous access cannot be established, an intra- osseous needle can be placed in the tibia ( Figure 19.1 ) or the - humeral head, which has the benefit of being easily accessed by an anaesthetist. age-adjusted cardiovascular parameters. Initially , 10 /uni00A0 mL/kg of a warmed isotonic fluid is given. Total blood volume (TBV) is around 85 /uni00A0 mL/kg in a neonate, rising to 100 /uni00A0 mL/kg at 1 /uni00A0 month and then falling to 75–80 /uni00A0 mL/kg in a child. Major haemorrhage is defined as loss of 50% of TBV in <3 /uni00A0 hours, 100% in 24 /uni00A0 hours or >20% in <1 /uni00A0 hour, but is challenging to assess, especially in blunt trauma. Hospitals should have a major haemorrhage protocol. If the capillary refill is >2 /uni00A0 seconds and the child has lost mainly blood, then blood is given, using O rhesus-negative blood until type-specific or cross-matched blood is available. Severe trauma-induced coagulopathy is best managed by correcting specific coagulation factors and using point-of-care testing thromboelastography (TEG) and thromboelastometry (ROTEM), but if these are not available the following are given: packed cells 20 /uni00A0 mL/kg, fresh-frozen plasma 20 /uni00A0 mL/kg, platelets 10 /uni00A0 mL/kg and cryoprecipitate 5 /uni00A0 mL/kg, and repeated maintaining these ratios and aiming for 9 a haemoglobin level >80 /uni00A0 g/L, platelets >75 /uni00A0×/uni00A0 10 /L, fibrinogen >1.5 /uni00A0 g/L and activated partial thromboplastin time (APTT)/ prothrombin time (PT) <1.5 /uni00A0×/uni00A0 normal midpoint. If the major haemorrhage occurred within 3 /uni00A0 hours, a slow tranexamic acid bolus of 15 /uni00A0 mg/kg followed by an infusion (15 /uni00A0 mg/kg over 8 /uni00A0 hours) should be given.

1–3 cm Figure 19.1 The intraosseous needle is inserted into the proximal tibia’s medullary cavity about 1–3 cm below the tibial tuberosity.

Resuscitation

All children initially receive high-flow oxygen, preferably via - a non-rebreathe mask; this can be stopped if there is cardio - respiratory stability after a period of observation. Intubation and ventilation are required if oxygenation is inadequate or if there is a low GCS, combative behaviour, an inability to cooperate, severe burns, prolonged seizures or imminent oper - ative intervention. Ideally , seriously injured children require two large well-secured cannulae. Alongside the antecubital fossa, other suitable veins include the long saphenous a t the ankle, the femoral, the external jugular and, in neonates, scalp veins. If intravenous access cannot be established, an intra- osseous needle can be placed in the tibia ( Figure 19.1 ) or the - humeral head, which has the benefit of being easily accessed by an anaesthetist. age-adjusted cardiovascular parameters. Initially , 10 /uni00A0 mL/kg of a warmed isotonic fluid is given. Total blood volume (TBV) is around 85 /uni00A0 mL/kg in a neonate, rising to 100 /uni00A0 mL/kg at 1 /uni00A0 month and then falling to 75–80 /uni00A0 mL/kg in a child. Major haemorrhage is defined as loss of 50% of TBV in <3 /uni00A0 hours, 100% in 24 /uni00A0 hours or >20% in <1 /uni00A0 hour, but is challenging to assess, especially in blunt trauma. Hospitals should have a major haemorrhage protocol. If the capillary refill is >2 /uni00A0 seconds and the child has lost mainly blood, then blood is given, using O rhesus-negative blood until type-specific or cross-matched blood is available. Severe trauma-induced coagulopathy is best managed by correcting specific coagulation factors and using point-of-care testing thromboelastography (TEG) and thromboelastometry (ROTEM), but if these are not available the following are given: packed cells 20 /uni00A0 mL/kg, fresh-frozen plasma 20 /uni00A0 mL/kg, platelets 10 /uni00A0 mL/kg and cryoprecipitate 5 /uni00A0 mL/kg, and repeated maintaining these ratios and aiming for 9 a haemoglobin level >80 /uni00A0 g/L, platelets >75 /uni00A0×/uni00A0 10 /L, fibrinogen >1.5 /uni00A0 g/L and activated partial thromboplastin time (APTT)/ prothrombin time (PT) <1.5 /uni00A0×/uni00A0 normal midpoint. If the major haemorrhage occurred within 3 /uni00A0 hours, a slow tranexamic acid bolus of 15 /uni00A0 mg/kg followed by an infusion (15 /uni00A0 mg/kg over 8 /uni00A0 hours) should be given.

1–3 cm Figure 19.1 The intraosseous needle is inserted into the proximal tibia’s medullary cavity about 1–3 cm below the tibial tuberosity.

Resuscitation

All children initially receive high-flow oxygen, preferably via - a non-rebreathe mask; this can be stopped if there is cardio - respiratory stability after a period of observation. Intubation and ventilation are required if oxygenation is inadequate or if there is a low GCS, combative behaviour, an inability to cooperate, severe burns, prolonged seizures or imminent oper - ative intervention. Ideally , seriously injured children require two large well-secured cannulae. Alongside the antecubital fossa, other suitable veins include the long saphenous a t the ankle, the femoral, the external jugular and, in neonates, scalp veins. If intravenous access cannot be established, an intra- osseous needle can be placed in the tibia ( Figure 19.1 ) or the - humeral head, which has the benefit of being easily accessed by an anaesthetist. age-adjusted cardiovascular parameters. Initially , 10 /uni00A0 mL/kg of a warmed isotonic fluid is given. Total blood volume (TBV) is around 85 /uni00A0 mL/kg in a neonate, rising to 100 /uni00A0 mL/kg at 1 /uni00A0 month and then falling to 75–80 /uni00A0 mL/kg in a child. Major haemorrhage is defined as loss of 50% of TBV in <3 /uni00A0 hours, 100% in 24 /uni00A0 hours or >20% in <1 /uni00A0 hour, but is challenging to assess, especially in blunt trauma. Hospitals should have a major haemorrhage protocol. If the capillary refill is >2 /uni00A0 seconds and the child has lost mainly blood, then blood is given, using O rhesus-negative blood until type-specific or cross-matched blood is available. Severe trauma-induced coagulopathy is best managed by correcting specific coagulation factors and using point-of-care testing thromboelastography (TEG) and thromboelastometry (ROTEM), but if these are not available the following are given: packed cells 20 /uni00A0 mL/kg, fresh-frozen plasma 20 /uni00A0 mL/kg, platelets 10 /uni00A0 mL/kg and cryoprecipitate 5 /uni00A0 mL/kg, and repeated maintaining these ratios and aiming for 9 a haemoglobin level >80 /uni00A0 g/L, platelets >75 /uni00A0×/uni00A0 10 /L, fibrinogen >1.5 /uni00A0 g/L and activated partial thromboplastin time (APTT)/ prothrombin time (PT) <1.5 /uni00A0×/uni00A0 normal midpoint. If the major haemorrhage occurred within 3 /uni00A0 hours, a slow tranexamic acid bolus of 15 /uni00A0 mg/kg followed by an infusion (15 /uni00A0 mg/kg over 8 /uni00A0 hours) should be given.

1–3 cm Figure 19.1 The intraosseous needle is inserted into the proximal tibia’s medullary cavity about 1–3 cm below the tibial tuberosity.