Pediatric thoracic trauma

Abstract

When treating pediatric trauma patients, many important differences must be considered when compared to adults. It may be diffi cult to have access to emergency vascular treatment especially in cases of shock or cardiac arrest. Interosseous access is an important option in all children and is more commonly implemented in the very young. Children have a smaller blood volume and a more insidious onset of hemorrhagic shock, commonly with tachycardia, as the only early warning sign. Regarding thoracic injuries, children have a markedly compliant thorax making them vulnerable to intrathoracic injury without overlying bony injury. It is crucial to be vigilant while evaluating children with blunt trauma injuries. The pediatric mediastinum is also very mobile allowing it to be shifted with much less intrathoracic pressure. Susceptibility to tension pneumothorax or hemothorax is much greater and these injuries must be treated promptly. This mobility, however, does make it less susceptible to major vascular or airway injuries. Thoracic trauma in children is a marker for the presence of associated injuries, found in more than 50% of these children. Children are much less likely to have concomitant systemic illnesses compromising their respiratory and cardiovascular reserves. This allows lower morbidity and mortality rates with aggressive medical therapy and faster recovery from injury. © 2009 Springer Berlin Heidelberg.