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  • Paediatric Trauma - DR Nicole Williams

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    Jesse Helmut Hansen-Bartel
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    This document discusses the role of rural GPs in paediatric trauma. It outlines that GPs are important for prevention efforts like education, early care of injuries, and ongoing care once patients are discharged from the hospital. For early care, the document details the steps for primary and secondary surveys to properly assess and stabilize injured children. It emphasizes the role of the Women's and Children's Health Network in Adelaide for definitive care of severe trauma cases. Ongoing care involves monitoring for complications and communicating with GPs to ensure stability once back in the community.

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    Paediatric Trauma - Dr Nicole Williams

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    This document discusses the role of rural GPs in paediatric trauma. It outlines that GPs are important for prevention efforts like education, early care of injuries, and ongoing care once patients are discharged from the hospital. For early care, the document details the steps for primary and secondary surveys to properly assess and stabilize injured children. It emphasizes the role of the Women's and Children's Health Network in Adelaide for definitive care of severe trauma cases. Ongoing care involves monitoring for complications and communicating with GPs to ensure stability once back in the community.

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    © All Rights Reserved
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    15 views36 pages

    Paediatric Trauma - DR Nicole Williams

    Uploaded by

    Jesse Helmut Hansen-Bartel
    This document discusses the role of rural GPs in paediatric trauma. It outlines that GPs are important for prevention efforts like education, early care of injuries, and ongoing care once patients are discharged from the hospital. For early care, the document details the steps for primary and secondary surveys to properly assess and stabilize injured children. It emphasizes the role of the Women's and Children's Health Network in Adelaide for definitive care of severe trauma cases. Ongoing care involves monitoring for complications and communicating with GPs to ensure stability once back in the community.

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    of 36

    Paediatric Trauma:

    What is the role of the rural GP?

    Dr Nicole Williams
    Director, WCH Paediatric Trauma Service
    Paediatric Trauma

    > Prevention

    > Early care

    > Ongoing care

    Women’s and Children’s Health Network


    Paediatric Trauma in Australia

    > No 1 cause of death 1 – 17 years

    > No 2 cause of hospital admission

    > 95% of deaths accidental ? preventable

    Women’s and Children’s Health Network


    Women’s and Children’s Health Network
    Region WCH Trauma (N = 4513)

    Far North 136


    Fleurieu and KI 131
    Eyre Western 155
    Limestone Coast 144
    Barossa, Light, Lower North 289
    Murray and Mallee 331

    Adelaide Hills 441


    Yorke and Mid North 313

    Adelaide Metropolitan 2429


    Interstate 144

    Women’s and Children’s Health Network


    Trauma at WCH

    > 463 trauma presentations 2015


    • 52 Level 1
    • 411 Level 2

    > 3 deaths

    > 27 PICU admissions

    > Fall <5m, MVC, MCC, bicycle, horse-riding

    Women’s and Children’s Health Network


    Prevention

    > Legislation

    > Education

    Women’s and Children’s Health Network


    Quad bikes

    > RACS has called for ban < 16 years

    Women’s and Children’s Health Network


    Quad bikes

    > No 1 cause death QLD rural properties

    > No 1 cause injury Australian farms

    > 97 Australian deaths 2011-15


    • 16 deaths <18 years

    - Safe Work Australia 2016

    Women’s and Children’s Health Network


    Women’s and Children’s Health Network
    Women’s and Children’s Health Network
    Rules for quad bikes

    > They are not all terrain vehicles

    > No children on adult bikes

    > No children as passengers

    > Appropriate safety gear

    > Appropriate training

    Women’s and Children’s Health Network


    Trampolines

    Women’s and Children’s Health Network


    “Pediatricians should counsel their
    patients and families against
    recreational trampoline use”

    - AAP 1999, updated 2012

    Women’s and Children’s Health Network


    Trampolines

    > 400+ presentations per year to WCH ED

    > 70% supervised

    > Voluntary Australian Safety Standard


    2003
    • No effect

    > 1/3 fell off trampoline

    Women’s and Children’s Health Network


    Women’s and Children’s Health Network
    Rules for trampolines

    > Do not place on concrete

    > Well-maintained safety equipment

    > No child under 6

    > One child at a time

    > No balls or other toys

    > No flips
    Women’s and Children’s Health Network
    Recognise Non-Accidental Injury

    > 80% of paediatric rib fractures are NAI

    > Femur fracture non-walking age

    > Corner and bucket handle fractures

    > Subdural haematomas

    > Multiple fractures different ages

    Women’s and Children’s Health Network


    Early Paediatric Trauma Care

    Women’s and Children’s Health Network


    Women’s and Children’s Health Network
    Women’s and Children’s Health Network
    Early Management of Severe Trauma

    > Primary survey

    > Resuscitation

    > Secondary survey

    > Definitive care

    Women’s and Children’s Health Network


    Primary Survey

    > Airway and C spine control

    > Breathing

    > Circulation and haemorrhage control

    > Disability

    > Exposure

    Women’s and Children’s Health Network


    Airway and C spine

    > Neutral neck

    > Clear nose

    > Difficult
    intubation

    > Upper C spine


    at risk of injury
    ijciis.org

    Women’s and Children’s Health Network


    Breathing

    > Decompress
    stomach

    > Beware muscle


    fatigue
    • ↓ type I fibres

    > Hypoxia 
    bradycardia

    Women’s and Children’s Health Network


    Circulation

    > Hypotension with > 25%


    intravascular volume loss

    Women’s and Children’s Health Network


    Disability

    > Bulging fontanelle with  ICP


    • eg. intracranial haemorrhage

    > Sunken fontanelle with


    significant blood loss

    Women’s and Children’s Health Network


    Exposure

    > Single impact can  multiple


    organ injury

    > Minimise heat loss

    > Monitor glucose

    Women’s and Children’s Health Network


    Secondary Survey
    > Trauma x-rays

    > Head/neck
    > Chest
    > Abdomen
    > Perineum
    > Back
    > Neurological
    > Extremities

    > Additional imaging


    Women’s and Children’s Health Network
    Definitive Care

    > <16 years WCH

    > ≥16 years to FMC/RAH

    > Major trauma call SAAS MedSTAR


    • 13STAR (13 78 27)

    Women’s and Children’s Health Network


    Tertiary Survey

    > Repeat secondary survey at 24 hours

    Women’s and Children’s Health Network


    Ongoing care

    > WCH
    • ED, PICU, anaesthesia
    • Paed surg, ortho, neurosurg, ENT, plastics,
    craniofacial, ophthal, dental
    • Rehab, haematology, gen med, DPM
    • Social work, physio, OT, speech path, dietician

    > GP = stability

    Women’s and Children’s Health Network


    Women’s and Children’s Health Network
    Ongoing Care

    > Poor communication is a problem

    > WCH Trauma CPC now phones all


    trauma patients post-discharge

    Women’s and Children’s Health Network


    Further information

    > EMST courses: RACS

    > Online resources


    • RCH Melbourne
    • Kidsafe
    • Day of Difference Foundation

    > WCH Trauma CPC:


    [email protected]

    > WCH Trauma Director:


    [email protected]
    Women’s and Children’s Health Network
    Women’s and Children’s Health Network

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