Paediatric Trauma Scenario 1
Airway Scenarios
Experience Summary
In this 360-degree video, observe the A to E assessment and management of a child who has fallen down the stairs, and sustained blunt trauma to the neck.
Clinical Context
In paediatric trauma, the initial approach to patient assessment is guided by the principles of Advanced Trauma Life Support (ATLS), with the primary survey being the cornerstone of immediate care. This systematic, rapid evaluation is designed to identify and address life-threatening injuries in a structured sequence: Airway, Breathing, Circulation, Disability, and Exposure (ABCDE).
Children have unique anatomical and physiological differences that make trauma assessment more complex. Smaller airway diameters, greater chest wall compliance, and limited blood volume mean that deterioration can occur more rapidly than in adults. Therefore, timely and accurate assessment during the primary survey is critical.
- Airway (with cervical spine protection): The airway is assessed first, with simultaneous attention to cervical spine immobilisation. In trauma, airway compromise can result from facial fractures, bleeding, or soft tissue swelling—conditions where ENT expertise may be crucial.
- Breathing and Circulation: Adequacy of ventilation and perfusion is assessed, with rapid intervention for issues like tension pneumothorax or haemorrhage.
- Disability and Exposure: Neurological status is evaluated, and the child is fully exposed to identify hidden injuries while preventing hypothermia.
The ENT (Ear, Nose, and Throat) team plays a vital role in managing complex neck and upper airway injuries, particularly when airway compromise is suspected. Paediatric patients may present with blunt or penetrating trauma to the neck, which can involve critical structures such as the larynx, trachea, pharynx, and major vessels.
ENT involvement is often necessary for:
- Airway assessment and management: In cases of suspected laryngeal trauma, stridor, hoarseness, or subcutaneous emphysema, the ENT team can perform flexible nasendoscopy to evaluate the airway. They may also assist or lead in establishing a surgical airway if intubation is not possible.
- Neck wound evaluation: In penetrating neck trauma, ENT specialists help assess the extent of soft tissue and vascular injury and decide on surgical exploration.
- Hemorrhage control: Bleeding from nasal or oropharyngeal sources may require ENT intervention, especially when conventional measures fail.
Learning Outcomes
- Understand the steps of a primary survey in the injured child.
- Observe an ENT focussed assessment of the neck and airway of a child with blunt trauma.
- Understand the roles of the trauma and ENT teams in this context.
External Resources
