1) Smaller body mass = greater force applied per unit body area (Kinetic
energy = ½ mv2). More intense energy transmitted leading to a higher
frequency of multiple organ injuries.
2) Larger heads = increased frequency BHT
3) Immature skeleton is more compliant; thus, internal damage often present
without overlying bony abnormalities.
4) Pediatric patients can maintain CV stability until 35-45% blood volume
lost which can cause "sudden" onset of irreversible shock. Kids will often
not become hypotensive until it´s too late.
5) Larger body surface area = increased risk of thermal energy loss.
6) Organs are closer to surface placing them at higher risk of injury.
7) Shorter period of stability after injury secondary to decreased reserve.
8) Pediatric airway anatomy increases obstruction risk secondary to
- Large head
- Short neck
- Small mandible
- cephalad, anterior, floppy epiglottis
- Large, posteriorly-placed tongue
- Small trachea
9) Both large head and increasingly mobile neck (ligamentous laxity)
predispose to c-spine injuries.
10) Compliance of child´s chest wall results in greater transmission of
forces within the thoracic skeleton resulting in pulmonary contusion or
hemorrhage. Additionally, mobility of the mediastinal structures in
children makes them more sensitive to tension pneumothorax. (Chest injuries
are the second leading cause of death in pediatric trauma)
*Common Mechanisms of Injury in Pediatric Trauma*
MECHANISM: INJURIES
Pedestrian struck Low speed: Lower extremity fractures
High speed: Multi-systems, head and neck, lower extremity
Automobile occupant Unrestrained: Multi-systems, head and neck, scalp, face
Restrained: Chest, abdomen, lower spine
Fall from height Low: Upper extremities
Medium: Head and neck, upper and lower extremities
High: Multi-system, head, neck, upper and lower extremities
Bicycle With helmet: Upper extremities
Without helmet: Head and neck
Handlebar strike: Abdominal, pelvis
Thanks to Dr. Shannon Staley for this post.
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