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Pediatric Fluids In Trauma

Pediatric Fluids In Trauma. Tom Poulton M.D. The Challenge. “They are not just little adults!”. What we shall cover. Historical Context Stereotypes The “Research” ATLS and Others Practical Guidelines. My background. Peds Anesthesiologist Peds Intensivist

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Pediatric Fluids In Trauma

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  1. Pediatric Fluids In Trauma Tom Poulton M.D.

  2. The Challenge • “They are not just little adults!”

  3. What we shall cover • Historical Context • Stereotypes • The “Research” • ATLS and Others • Practical Guidelines

  4. My background • Peds Anesthesiologist • Peds Intensivist • 30 years Level I Trauma Centers • PALS Instructor • PALS Instructor • Medical Director Urban EMS Programs • Medical Director Flight Program • U.S. Navy Field Hospital

  5. Fluid Resuscitation • Curious phrase?

  6. Resuscitation • Origins • Why “fluid resuscitation”?

  7. Historical Evolution • Don’t give kids too much • Give ‘em more • That’s it • No, not that much

  8. Ask a Pro • “Well, in general, non-experts are too stingy with fluids in trauma patients”

  9. Fair Question • So, do you want us to give too much or too little?

  10. What is the Goal? • Restore circulating blood volume • Restore aerobic metabolism • Avoid organ injury

  11. Restoring Volume • Fluids are cheap. Why not be generous?

  12. Restoring Volume--Downsides • Dilution • Coagulation • Edema where we don’t want it • …and worse stuff

  13. How We Die? • Acidosis

  14. What are we designed to tolerate? • Acidosis

  15. Edema

  16. Target • Not too much • Not too little • Just right…

  17. Gimme a break!! • What’s the standard?

  18. Standards • ATLS • European Union • Australian Trauma Society • Norwegian Trauma Alliance • My Uncle Fred

  19. Practical Norwegians • Treat until you have a periph pulse • Nl BP minus 20% if no TBI • Nl BP if TBI

  20. Starting Point • How much? • Who needs more than 20ml/kg?

  21. General Consensusas of this morning… • Healthy kids compensate well • Any Drop in BP: Probably > 30% BV

  22. Uh, is the BP low?? • Depends on knowing what normal BP is. • That may depend on knowing about what the age is. • Broselow tape may help. • Better have atable of normal BPs.

  23. What can I rely on?? • Cap refill • The Gestalt • This is not rocket science

  24. Who Needs Blood?

  25. Some Practical Stuff • Venous Access • Two large-bore IVs • Intraosseous • Central Lines • Swoop and Scoop • Stay and Play

  26. Bottom Line • Bleeding is a surgical problem. • Surgery fixes ongoing bleeding. • Extra IVs don’t help much. • Extra time at the scene doesn’t help much. • Ten minutes at the scene won’t help anything. • Knowing the immunization history isn’t going to help.

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