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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...