Pedi Pointers and Pertinent Propaganda

[Bob Waddell II]

Great question.  Be careful with Waddell's Triad as the research by some
accounts may be flawed.  The actual bottom line besides "creamed" is that
the various points of impact vary with both the childs' size, speed of the
vehicle, and the specific vehicle involved.  A Porsche impacting a 16 y/o at
15 mph will result in a potentially different injury pattern than that seen
in a 5 y/o impacted by a Ford Excursion traveling at 15 mph.

Consideration or thought may need to be given to the use of restraints -
spinal or otherwise - in children.  The simplest analogy (neither evidence
based nor politically correct) is: "Bondage is a learned enjoyment not
instinctive."  Restraining a child often produces "animal like instincts
such as escape.  The twisting, turning, fighting, and other actions known
seen are known to increase the potential of aggravating existing injuries.

Over the past few years a number of pediatric transport restraint systems
have entered the market.  Caution must be used to assure they have been
dynamically crash tested and not simply material tested.

Over triage is a concern in the pediatric trauma world.  Studies have shown
as much as a 70% over triage in children versus their adult counter parts.
Care must be taken to assure the proper care and resources are provided to
all patients based on expected survivability not age.  People get hurt by
emotions, even the other patients we try to save.

Best wishes with your presentation.

PS: one of my other hats is as the Chair of the Emergency Pediatric Care
program for the NAEMT. 

Take care, 
  
Bob 
  
Robert K. Waddell II 
Vice President - 
Emergency Preparedness and Response 
"The Sacco Triage Methodology" 
ThinkSharp, Inc 
  
Wyoming Office: 
1302 East 5th Avenue 
Cheyenne, Wyoming 82001 
(307) 920 - 2020 cell 

bwaddell at sharpthinkers.com 
or bobwaddell at bresnan.net 
www.sharpthinkers.com 


-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Bjorn, Pret
Sent: Monday, September 24, 2007 11:05 AM
To: Trauma & Critical Care mailing list
Subject: Pedi Pointers and Pertinent Propaganda

I'm speaking to a group of nurse anesthetists this weekend who want to
know cool stuff about pediatric trauma.  I've got a couple of canned
lectures on my hard drive, but they (and surely I) could use some
freshening up.

Apart from various spins on "kids are / are not little adults," what's
the coolest thing you know about pediatric trauma?

Techniques, tips, trivia -- if it's germane to kids and trauma, I'd love
to hear it and pass it along (after cursory verification, of course).  

For example, it was the Trauma-List that taught me how SCIWORA is more
common in adults than kids, and that Waddell's Triad is just another way
of saying that when a child gets hit by a car, he basically gets
creamed.

If you have background references, great; if not I'll happily reference
YOU.

I thank you, and scores of Maine nurse anesthetists are subconsciously
in your debt.

Pret Bjorn, RN
Bangor, ME USA

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