Pediatric Trauma at Adult Level 1
Modified ATLS and transfer workflow for pediatric patients (<15yo) at Highland.
Updated: 05/05/2025
PediatricBroselowTXAIOCHOOn this page4 sectionsHide sections
⚠️ Broselow tape for ≤12yo. Weight-based dosing required.
⚠️ Stabilize hemodynamically before transfer to CHO.
🩸Primary Survey — C-A-B-C-D-E
▼C
Catastrophic bleeding first
Control before airway: tourniquet, pelvic binder, or expedited transfer to OR. Transfuse actively during this time.
A
Airway
Under 1 year, a cervical collar may not be sufficient — use manual in-line stabilization or positioning with sandbags/towels. C-spine immobilization only for blunt mechanism.
B
Breathing
Use Broselow for ET tube sizing. Pigtail catheters for chest decompression in small children.
C
Circulation
Immediate IO for any child in extremis. Ultrasound-guided IV if preferred. Escalate to EJ, femoral line, or saphenous cut-down.
D
Disability
Check glucose — consider dextrose.
E
Exposure
WARM the patient immediately. Aggressive warming at all times.
🩸Circulation & Transfusion
▼- Immediate IO for any pediatric patient in extremis
- 1:1:1 transfusion (if <30kg: 10mL/kg PRBC + 10mL/kg FFP)
- Calcium 100–200 mg/kg IV over 5–10 min after 2 rounds of MTP; recheck ionized calcium hourly during MTP
- Crystalloid, if used: 20 mL/kg
💊
TXA (confirm with pharmacy):
Age >12: 2g IV once
Age <12: 15 mg/kg IV over 10 min, then 2 mg/kg/hr ×8h
Age >12: 2g IV once
Age <12: 15 mg/kg IV over 10 min, then 2 mg/kg/hr ×8h
✈️Transfer to CHO — Goal ≤20 min
▼- Stabilize hemodynamically BEFORE transfer
- Log roll immediately after the primary survey; secondary survey per standard trauma protocol
- Notify PICU, anesthesia, and blood bank as early as possible
- If ongoing hemorrhage → OR first
- Place NG/OG and foley before transfer
- Suspected isolated head injury → call CHO first before getting CT
- Defer CT chest/abd/pelvis unless directed by CHO
🖥️Imaging & FAST
▼Unstable:
- FAST for unstable blunt pediatric trauma
- Radiographs per Trauma Attending for Level 1 activations
Stable:
- ATLS protocol with documented vital signs
- Radiographs only if warranted (high-energy mechanism, direct thoracic trauma) — notify Trauma Attending
- FAST liberally if there is any concern; report any positive FAST to the Trauma Attending
- Suspected isolated head injury and stabilized → call CHO and start transfer; image only as CHO recommends
- Status
- AHS Official Protocol
- Source
- Pediatric_Trauma.docx
- Last reviewed / updated
- 05/05/2025