1. Provide a secure patent airway
2. Supply supplementary oxygen
3. Support ventilation
4. Prevent hypoxia and aspiration

These goals are the same for the pediatric and the adult patient. Accurate assessment of the respiratory status is especially important in children. A known pitfall in trauma management is under-resuscitation and resulting hypoxia. Hypoxia is the main reason children go into cardiac arrest.

Assessment of the Pediatric Respiratory Status

1. Pediatric vital signs must be compared with age-related normal values. The Handtevy App is useful here.
2. Pulse oximetry is a useful adjunct for monitoring a child's respiratory status but the gold standard is end tidal CO2 (ETCO2) monitoring. We should let ETCO2 drive management on all our patients with respiratory issues.
3. Evaluation of overall general appearance (e.g., posture, level of alertness, or responsiveness) and other organ systems such as CNS (e.g., lethargy, agitation, or other altered mental status) and skin (e.g., pallor, cyanosis, or delayed capillary refill) also will aid the recognition of respiratory distress and impending respiratory failure in a child because a child's brain consumes a lot of oxygen and hypoxia may result in alteration here.
4. Assess respiratory effort for the following:

• Tachypnea, an early sign of distress. This is how a child preserves minute volume.
• Chest rise or abdominal excursion (the way the diaphragm moves) can reveal the adequacy of the trauma patient's respirations and tidal volume.
• Listen for respiratory noises (e.g., snoring or stridor indicating upper airway obstruction; wheezes indicate lower airway obstruction; and grunting, ominous for severe respiratory distress) are indications of work of breathing and airway obstruction.

The Bureau will soon be providing agencies with high flow nasal cannula devices and we look forward to protocol direction on how to best use these in the prehospital pediatric realm.

Chest injury in children is rare but often deadly. Blunt or penetrating, numerous potential complicating diagnoses can result from chest trauma. Some require more emergent interventions than others. Scene times should be as short as possible for severely injured patients. Transport should not be delayed to perform procedures that are not life threatening.

There are cases when a life threatening injury does need immediate intervention.

• Blunt chest trauma, shortness of breath, asymmetric lung sounds, deviated trachea, crepitus, hypotension, or a hemodynamically unstable patient are all suspicious for tension pneumothorax. Needle decompression should be considered.

"Prehospital management often depends on the level of service of the transporting team; in the United States, this consists of basic life support (BLS) and advanced life support (ALS). Basic interventions include non-invasive airway management, cardiopulmonary resuscitation and defibrillation, hemorrhage control, spine immobilization, and splinting/stabilization of extremity fractures. More advanced techniques include advanced airway interventions (including endotracheal intubation), administration of select medications, cardiac monitoring, and needle decompression. Availability of transport services, as well as the capabilities of destination hospitals, vary greatly throughout different geographic settings, and special considerations must be taken based on local resources and facilities."3

Join us on Zoom today for PETOS at 2pm. Dr. Katie Russell, the trauma medical director at Primary Children's will present an in-depth bronchial injury case.

Additional Resources on the Topic

November 18th from 0730-0830 MST: Trauma Grand Rounds–Dr. John Skaggs will present on Airway Management in Trauma (see below)

References

1. The Pediatric Airway and Rapid Sequence Intubation in Trauma
2. Managing the Airway of the Pediatric Trauma Patient: Meeting the Challenge
3. EMS Chest Injury

Injuries are the leading cause of death and disability to U.S. children from one to 18 years old. Every day, 20 children die from preventable injuries, resulting in more deaths than all other diseases combined. In fact, injury is the leading cause of death for people through 44 years of age.

On Thursday, November 18, 2021, the Injury Free Coalition for Kids and the country's leading injury and violence prevention organizations will join forces for the 2nd annual "National Injury Prevention Day," a day designed to raise awareness about the burden of injury, violence, and a need for change. Joining doctors, nurses, and community outreach personnel at Trauma Centers across the country will be Safe Kids Worldwide, Safe States Alliance, the American Trauma Society, the American Academy of Pediatrics, Everytown for Gun Safety, The Society for Advancement of Violence and Injury Research, the Trauma Center Association of America and Juvenile Products Manufacturers Association Cares.

Resources

• 2021 National Injury Prevention Day Flier (PDF)
• Record of last year's inaugural National Injury Prevention Day
• NIPD Resources, including promotional materials and artwork for use by partners
• Submit Event Information

NASEMSO Annual Meeting

Set for November, the pandemic forced cancellation of 2021 NASEMSO Annual Meeting.

FDA authorizes Pfizer COVID-19 vaccine for ages 5-11

Pfizer’s COVID-19 vaccine for children ages 5 to 11 was given emergency use authorization by the Food and Drug Administration (FDA) last week. The agency said clinical trials have shown the vaccine is 90.7% effective in the age group and no serious side effects were detected. The Centers for Disease Control and Prevention (CDC) has released clinical recommendations for the vaccine and the shot is now available for kids ages 5 to 11.

The Utah Department of Health is sharing the attached COVID-19: Response Report detailing caseloads and vaccination rates among Utah's school-aged children, COVID-19 related hospital and ICU capacity, and monoclonal antibody treatments. This report provides a high-level overview of where we are as a state in these key areas.

The report can be found in the blue box at https://coronavirus.utah.gov/education. The report is also available in Spanish at https://coronavirus.utah.gov/educacion.

We also encourage you to visit coronavirus.utah.gov/case-counts/ where you can find a searchable database for information on individual schools throughout the state as well as additional information on caseloads, vaccinations, testing, hospitalizations, and more. You may also wish to visit your local health department or local school district COVID-19 dashboards for information on cases in your local schools.

Covid-19 Trackers

Johns Hopkins Global tracker (desktop)

Johns Hopkins Global tracker (mobile)

Utah Department of Health