Paediatric trauma and resuscitation.
Severe paediatric trauma differs from adult trauma in that blunt trauma, and especially head trauma, represents 98% of cases. In these instances, early control of the airways, prompt haemodynamic stabilization, emergency explorations and further conservative management of bleeding abdominal lesions are the most challenging issues. On-scene resuscitation, primary stabilization before transportation and transfer to a specialized centre are mandatory. The pre-hospital management of injured children, however, is frequently neglected. The need for emergency intubation and rapid intravenous access insertion is difficult to meet, in spite of many attempts to ameliorate this situation. The option of conservative surgical management of spleen and liver lesions has been extensively developed, and is now applied in many paediatric institutions with a high rate of success. A better application of on-scene resuscitation and of the selective management of bleeding lesions is the key to the prevention of secondary lesions, representing a major source of avoidable death and long-term sequelae.
Meyer
P G
PG
Assistance Publique Hopitaux de Paris, Hopital des Enfants Malades, Département d'Anesthesie-Reanimation Chirurgicale, 149 rue de Sevres, Paris 75015, France.