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PEDIATRIC TRAUMA SYSTEMS IN TAMIL

NADU: AN OVERVIEW

Indumathy Santhanam MD,

DCH,
Professor
Paediatric emergency
Department,
Institute of Child health,
Madras Medical College
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Objectives
Trauma care in TN public
hospitals & requirements
Trauma reception in ED
Trauma protocols
Existing training in
emergency management
In hospital care including
access to radiology
Damage control surgery
Future directions
 Map of participating Pan Asian Trauma Outcomes Study
(PATOS) centres.

S. Shu-Ling
Chong, ChongURetKhan, I Santhanam
al. BMJ Open 2017;7:e015759 et al. A Retrospective review of
paediatric head trauma-Pan Asian Trauma outcomes study
collaboration BMJOPEN. Bmj.com 2017
2017 by British Medical Journal Publishing Group
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Limitation: Paediatric trauma registry lacking
in Asian countries

Conclusion: Among children

with head injuries, RTA,
endotracheal intubation and
neurosurgery independently
associated with death.

S. Chong, UR Khan, I Santhanam et al. A Retrospective review of

paediatric head trauma-Pan Asian Trauma outcomes study
collaboration BMJOPEN. Bmj.com 2017
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Medical colleges: Casualty

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OPD/Casualty in District hospitals

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Quality of Pre-hospital care

Note absence of
reservoir, oxygen and
small bag!

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Systems should help to correct life

threatening conditions in the ED

Airway &Breathing : Correct hypoxia with C-Spine precautions

Circulation: Correct shock and stop bleeding
Disability: Lower ICP and control seizures
Secondary Survey : identify trauma to other organs

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Trauma reception and resuscitation in ED

Resuscitation trolleys not cots

Bag valve mask (1-1.5 lts) at
head end
Suction with yankcouer tip
Central oxygen
Plug points 3 feet above the
ground (5 and 15 amps)
Crash cart
Syringe pumps and monitors

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Organization of paediatric trauma

services
BLOOD BANK

OT
CT/MRI Lab/

Radiology
surgeons

TRIAGE
HDU EMERGENCY

HOSPITAL ENTRANCE WITH AMBULANCE BAY

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Trauma reception: Team effort in airway
management and cervical immobilization

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Training in cervical immobilization:

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Team training needed for intubating trauma victim. 13

Mobilize suction and

airway nurses
Immobilize neck
Apply Sellicks/BURP
ICP precautions

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Ability to identify and treat pneumothorax

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Skills to treat Hemopneumothorax

Note intubation
Cervical stabilization
Shock correction in
progress
Thoracotomy

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Trained to identify and correct shock

Blood bank facilities essential

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OR/Surgeons should be available

close at hand and OT if
hypotensive

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EXPOSURE
Remove clothing for complete secondary survey

FAMILY
Liaison with the family through out resuscitation

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Secondary survey

Scalp lacerations can cause

loss of blood, resulting in
shock

Early saline irrigation,

debridement and suturing

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Maxillofacial and intra-oral trauma

Check for basal skull fracture,

nasal or oral trauma, tongue
laceration or/and injury or
avulsion of teeth
Irrigate with saline.
Administer antibiotics.
Preserve loose tooth for re-
implantation.
Call for urgent ophthalmologic
and plastic surgeon, if face,
eye or mouth are injured.
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Examination of chest

Examination of the Palpation of ribs and Percussion of chest

chest for symmetry chest for soft tissue
Resonance:
from the foot end of swelling and fracture
pneumothorax.
the victim of the ribs.
Dullness:
hemothorax.

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Blood in the vagina or rectum warrants

examination under anaesthesia.

Abdomen Perineum

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Examination of the muscles and long bones

for fracture or hematoma.

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Technique of log rolling needs minimum

4 trained hands.

Look for swelling, deformity, tenderness and gibbus. Note,

the on-going support for the neck during log roll and spinal
examination
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Pelvic stability test

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Concurrently.
Apply direct pressure
over open wounds.
Simultaneously,
realign the injured
limb or limbs in the
near anatomic
position.
Splint injured limbs

Pocket Pediatric Emergency Medicine Course for interns

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Interventions during secondary

survey

Antibiotics: Fractures,
craniofacial injuries and
abdominal trauma.
Tetanus prophylaxis.
Analgesia: Morphine (0.1
mg/kg/dose).
Fentanyl (1 g/kg/dose).
Paracetamol (15
mg/kg/dose PO/PR/NG

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Assess gross motor

function and
circulation of each limb

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Ability to perform Focused Assessment

Sonogram for Trauma (FAST)

Ensures rapid
assessment for free
fluid (bleed in
peritoneal space) in
abdomen, pleural
space and pericardial
sac

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Radiology should be available close to

the ED

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CT Facilities: 24 x 7 close to the ED.

Splenic rupture Pneumo- NGT in the

peritoneum chest

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Future directions: Strengthen Pre-Hospital care

How to retrieve victims

from the accident site
Jaw thrust
Clear airway
Provide oxygen
Apply spinal board during
log roll without
aggravating spinal injury.

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Future directions: Strengthen Pre-Hospital

care
Fixing the head to the Whole body immobilization
head immobilizer with using straps placed over the
straps provided for the chest, anterior iliac spine
purpose and over the knees.

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District Hospitals

Future directions
Secure the airway
Correct shock
Control bleed
Shift safely to higher
centres

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MEDICAL COLLEGES
Infra-structure:
Trauma resuscitation at
the entrance of the
hospital
Radiology (x-ray, CT, MRI)
Emergency OT near the
emergency
HDU
Blood bank
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Manpower
One doctor dedicated to
the emergency
One year fellowship
training in centres
offering round the clock
paediatric emergency
care training
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Paediatric Resuscitation and Emergency

Medicine PREM
NHM

PREM means "love, affection" in Sanskrit

FEMININE FORMS: Prema (Hindi),
Prema (Marathi), Prema (Tamil),
Prema (Kannada)
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One day workshop to sensitize doctors and nurses

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Future directions: On-site training in trauma

resuscitation for casualty medical officers for
PREM/TAEI at ICH
Trauma: Advocacy for prevention 39

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PREM Initiative by the NHM