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Abdomen Intraperitoneal air mandates a laparoscopy or laparotomy . Penetrating wounds that have not entered the abdominal cavity should be cleaned and closed. The spleen and liver account for 70% of all visceral injuries caused by blunt trauma. In the haemody...

DAMAGE CONTROL SURGERY Damage control surgery aims to break the ‘vicious cycle’ of hypothermia, tissue hypoxia, coagulopathy and acidosis before later definitive repair. Anatomy is restored when the physiology is optimised. The principles are in sequence: (i) s...

DEFINITIVE MANAGEMENT Chest A small pneumothorax detected on a chest radiograph may be observed rather than drained. Lung contusions require analgesia and chest physiotherapy to prevent secondary infection. Penetrating lung injuries may be assessed at either t...

Imaging The choice of imaging depends on the mechanism of injury and the findings on examination. Cross-sectional imaging can be invaluable, but a head-to-toe computed tomography (CT) scan should only be performed with good reason to limit exposure to ionisin...

Injury Severity Score An Injury Severity Score (ISS) (see Chapter 26 ) >15 predicts mortality in adults, but children require an ISS >25 for the same prediction; this is because most children have an isolated head or extremity injury . Only around 10% of child...

INTRODUCTION Trauma is the leading cause of death in children over 1 /uni00A0 year old, and blunt trauma is the most common mechanism. Prompt, guideline-driven management by a trauma team reduces complications and saves lives. For cranial injuries in children...

Learning objectives To be able to: Systematically assess an injured child • Give examples of how mechanisms of, and responses to, • injury differ from those in adults Distinguish the elements of the primary and secondary • surveys Explain when and how to trans...

Patterns of injury There are some well-recognised patterns of injury in children. Lap belt If a child experiences a forced flexion over a lap belt in a car accident, the small bowel or its mesentery or the bladder’s abdominal portion may get compressed agains...

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 inade...

SECONDARY SURVEY The secondary survey is performed after resuscitation and stabilisation. The history is reviewed and a complete clinical examination is performed to assess for other injuries. SECONDARY SURVEY The secondary survey is performed after resuscitat...

Specific considerations Spleen There is a risk of splenic pseudoaneurysm after splenic trauma, which is unrelated to the severity of the injury ( Table 19.1 Therefore, a follow-up ultrasound is recommended. Claude Couinaud , 1922–2008, French surgeon and anat...

Spinal cord injury without radiological abnormality (SCIWORA) Cervical hyperextension can occur during a rear impact in a car accident or from a frontal impact to the head. If such a mechanism dissipates a lot of energy , the spinal cord can be damaged even ...

Spinal cord injury without radiological abnormality (SCIWORA) Cervical hyperextension can occur during a rear impact in a car accident or from a frontal impact to the head. If such a mechanism dissipates a lot of energy , the spinal cord can be damaged even ...

THE PRIMARY SURVEY Injured children are assessed using the Advanced Trauma Life Support (ATLS) structured cABCDE approach: of catastrophic bleeding with pressure, A irway with C-spine control, B reathing with oxygen, C irculation with further control of haem...

Trauma-induced coagulopathy Tissue damage releases factors that encourage coagulation but acidosis and hypothermia prolong it; therefore, blood products should be warmed. For each 1°C fall in temperature, factor activity falls by 10%. Below 34°C clotting times...

After haemorrhage control Once haemorrhage is controlled, patients should be defini - tively resuscitated, warmed and have coagulopathy corrected. Attention should be paid to fluid responsiveness and the end - points of resuscitation to ensure that patients a...

Blood and blood products Blood is collected from donors who have been previously screened before donating to exclude any donor whose blood may have the potential to harm the patient or to prevent possible harm that donating a unit of blood may have for the do...

Blood groups and cross-matching Human red cells have on their cell surface many di ff erent - antigens. Two groups of antigens are of major importance in surgical practice /uni00A0 – /uni00A0 the ABO and rhesus systems. ABO system These proteins are strongly ...