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graph TD
classDef start fill:#1b5e20,color:#ffffff,stroke:#66bb6a;
classDef step fill:#0d47a1,color:#ffffff,stroke:#42a5f5;
classDef decision fill:#4a148c,color:#ffffff,stroke:#ab47bc;
classDef alert fill:#b71c1c,color:#ffffff,stroke:#ef5350;
A(Pediatric RTA Rapid cABCDE Survey):::start
B1[c Catastrophic Bleed Pressure and Tourniquet]:::step
B2[A Airway and C-Spine MILS and Rigid Collar]:::step
B3[B Breathing O2 and Treat Life-Threats]:::step
B4[C Circulation Fluids Blood IV or IO]:::step
B5[D and E Assessment GCS Pupils and Warmth]:::step
A --> B1
A --> B2
A --> B3
A --> B4
A --> B5
C[Trauma Adjuncts FAST X-Rays and Labs]:::step
B1 --> C
B2 --> C
B3 --> C
B4 --> C
B5 --> C
D{Stabilized}:::decision
C --> D
E[Unstable Emergency Surgery]:::alert
F[Secondary Survey Head-to-Toe and AMPLE]:::step
D -->|No| E
D -->|Yes| F
G1[Neurotrauma Mgmt ICP Control and Hypertonics]:::step
G2[Thoraco-Abdominal Mgmt Conservative Care or Surgery]:::step
F --> G1
F --> G2
H[Disposition Transfer to Level 1 Trauma]:::step
G1 --> H
G2 --> H
INTRODUCTION
Pediatric trauma requires a specialized approach due to unique anatomy (larger head-to-body ratio, compliant chest wall, smaller functional residual capacity).
Goal: Rapid identification and reversal of life-threatening injuries via the Primary Survey.
I. PRIMARY SURVEY (cABCDE Approach)
C (Catastrophic Hemorrhage): Identify and control massive external bleeding using direct pressure or tourniquets.
A (Airway with C-spine Protection):
Assess patency (vocalization, breath sounds).
Maintain neutral position (infants) or sniffing position (older children).
Manual In-Line Stabilization (MILS) for C-spine; rigid collar once sized.
B (Breathing & Ventilation):
High-flow O2 (15L/min via NRBM).
Inspect for tracheal deviation, chest rise, and neck vein distension.
Life-threats to exclude: Tension pneumothorax (needle decompression), Open pneumothorax, Massive hemothorax, Flail chest.
C (Circulation & Hemorrhage Control):
Assess: Heart rate (earliest sign of shock), CRT (>2 sec), pulse volume, BP (late sign).
Access: Two large-bore peripheral IVs; if unsuccessful <90 seconds/3 attempts, proceed to Intraosseous (IO) access.
Fluid Resuscitation: 20 mL/kg isotonic crystalloid bolus (repeat up to 40-60 mL/kg if needed).
Massive Hemorrhage Protocol: Blood products (10 mL/kg pRBCs) if non-responsive to crystalloids.