Emergency Department, Inpatient, and ICU Clinical Pathway for Children with Blunt Abdominal Solid Organ Injury
Age Adjusted Hemodynamic Parameters
Anything outside the vital signs below is concerning for hemodynamic instability.
Due to the physiologic reserve in children, blood pressure may be maintained despite a significant blood loss. Tachycardia is often the only compensatory method for pediatric patients who cannot increase their stroke volume. Hypotension is a LATE sign typically not present until Class III Hemorrhage (30% blood loss) has occurred.
Heart rate may also be affected by pain, anxiety, medications and hydration status.
Age | HR | Systolic BP | Diastolic BP |
---|---|---|---|
Newborn | 120 - 160 | 50 - 70 | 30 - 60 |
Infant (1 - 12 mos) | 80 - 140 | 70 - 100 | 53 - 66 |
Toddler (1 - 3 yrs) | 80 - 130 | 80 - 110 | 53 - 66 |
Preschooler (3 - 5 yrs) | 80 - 120 | 80 - 110 | 53 - 69 |
School Age (6 - 12 yrs) | 70 - 110 | 80 - 120 | 57 - 71 |
Adolescent (13+ yrs) | 55 - 105 | 110 - 120 | 66 - 80 |
Hemoglobin Stability
Stable Hgb is defined as two consecutive stable or up trending Hgb (including admit Hgb)
Fluid and Transfusion Indications
Administer blood rather than crystalloid if hemorrhagic shock is obvious
Volume | Comments | |
---|---|---|
Warmed Isotonic Crystalloid Solution NS or LR | 20 mL/kg |
|
Warmed O negative or type-specific warmed PRBC’s | 10 - 20 mL/kg |
|
Indications for Surgical Interventions
Angioembolism-Interventional Radiology (IR)
- Signs of acute or chronic bleeding despite PRBC transfusion
- Not indicated for contrast blush on admission CT alone without other indication for intervention (persistent anemia, tachycardia, etc.)
- IR should be avoided in unstable patients with profound or decompensated shock
Operative exploration-Operating Room
- Unstable VS despite PRBC transfusion
- Consider Massive Transfusion Protocol