ABC of major trauma. Paediatric trauma: secondary survey.

Abstract

Principles for the secondary survey * Children should be assessed systematically according to a strict protocol * Finding an injury should not stop the remainder of the evaluation * Always be gentle and pay particular attention to manipulation of the spinal cord axis * Vital signs should be recorded repeatedly After the primary survey, initial stabilisation of the cardiorespiratory system, and treatment of shock a complete physical examination takes place. Head and neck Ages at which acute subdural and extradural haematomas are usually seen in children and associated incidences ofseizures and skull fractures Acute subdural Extradural haematomas haematomas Age at which usually seen <12 months >2 years Associated incidence of seizures High (75%) Low (<25%) Associated incidence of skull fractures Low (30%) High (75%) IuoImpUtfU tUoimogrdaml snUwing rlyin subdural haematoma. As in adult patients fully examine the head for lacerations; the skull for fractures; the eyes for injury (also remember penetrating injury) and pupillary function; the ears and nose for leakage of cerebrospinal fluid; the face for fractures and lacerations; the mouth for loose teeth; and, finally, the neck for cervical displacement. Frequent assessment of the Glasgow coma score is essential. Primary brain damage that occurs at the time of the injury cannot be reversed. Secondary brain damage occurs as a result of cerebral hypoxia or ischaemia and can be minimised by maintaining oxygenation and an adequate cerebral perfusion pressure.