Severe Pediatric Traumatic Brain Injury
Evidence-based guidelines for prehospital pediatric traumatic brain injury care
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Jeremy DeWall, MD, NREMT-P, is a resident physician practicing emergency medicine at the Medical College of Wisconsin's Department of Emergency Medicine in Milwaukee. He has been a nationally registered paramedic for 10 years. In addition, he works as a flight physician for Flight for Life of Milwaukee.
Figure 1: Pediatric ETT Sizing
Pre-term-6 months: 2.5-4.0 uncuffed
1 year: 4.0-4.5 uncuffed
2+ years old: 16 + (age in years)/4 uncuffed
Depth: 3 x ETT size
No securing around the neck
| Sedation | |
| Etomidate 0.3 mg/kg | Thiopental 3-5 mg/kg |
| Fentanyl 2-4 mcg/kg | Midazolam 0.1-0.2 mg/kg |
| Paralysis | |
| Rocuronium 1 mg/kg | Vecuronium 0.3 mg/kg |
| Age | Eucapnea | Hyperventilation |
|---|---|---|
| Adults (9+) | 10 bpm | 20 bpm |
| Children (1-8) | 20 bpm | 25 bpm |
| Infants (under 1) | 25 bpm | 30 bpm |
| Normal values | Lower limits |
|---|---|
| American Heart Association. Pediatric Advanced LIfe Support Guidelines, 2000. | |
| - 50th percentile | - 5th percentile |
| SBP = 90 + (2 x age in years) | SBP = 70 + (2 x age in years) |
| Or use charts: | Neonates (0-28 days): SBP &llt;60 mmHg |
| Infants (1-12 months): SBP 7&llt;0 mm Hg | |
| Adolescents (>10 years old): &llt;90 mm Hg | |
| Reassess BP every five minutes. | |
| Eye Opening (E) | Verbal Response (V) | Motor Response (M) |
| Spontaneous (4) | Oriented (5) | Obeys (6) |
| Reacts to speech (3) | Confused (4) | Localizes (5) |
| Reacts to pain (2) | Inappropriate words (3) | Withdraws (4) |
| No response (1) | Incomprehensible sounds (2) | Flexor response (3) |
| Total = E+V+M | No response (1) | Extensor response (2) |
| No response (1) |
| Eye Opening (E) | Verbal Response (V) | Motor Response (M) |
| Spontaneous (4) | Coos, babbles (5) | Spontaneous movement (6) |
| Reacts to speech (3) | Irritable cry (4) | Withdraws to touch (5) |
| Reacts to pain (2) | Cries to pain (3) | Withdraws to pain (4) |
| No response (1) | Moans, grunts (2) | Flexor response (3) |
| Total = E+V+M | No response (1) | Extensor response (2) |
| No response (1) |
| Harriet Lane Textbook, John's Hopkins Hospital | ||
| Pre-term: 20-60 mg/dL | Newborn (under 1 day): 40-60 mg/dL | Newborn (>1 day): 50-80 mg/dL |
| Child: 60-100 mg/dL | >16 years of age: 74-106 mg/dL | |
