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<td height="30px"><span class="title"><a name="h1" id="h1"></a>Pediatric Terrorism and Disaster Preparedness </span></td>
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<td><div id="centerContent"><p><strong>Public Health Emergency Preparedness</strong></p> <div class="headnote">
<p>This resource was part of AHRQ's Public Health Emergency Preparedness program, which was discontinued on June 30, 2011, in a realignment of Federal efforts.</p>
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<p>Please go to <a href="https://www.ahrq.gov/">www.ahrq.gov</a> for current information.</p></div>
<h3>Table 7.3. Principles of Advanced Trauma Life Support&reg;</h3>
<table border="1" cellspacing="0" cellpadding="3" width="80%">
<tr valign="top">
<th scope="col">Principle</th>
<th scope="col">Description</th>
</tr>
<tr valign="top">
<th colspan="2" scope="row"><strong><em>Primary Survey and Resuscitation</em></strong></th>
</tr>
<tr valign="top">
<td scope="row" rowspan="6">Airway/cervical spine</td>
<td>Open: jaw thrust/spinal stabilization</td>
</tr>
<tr valign="top">
<td>Clear: suction/remove particulate matter</td>
</tr>
<tr valign="top">
<td>Support: oropharyngeal/nasopharyngeal airway</td>
</tr>
<tr valign="top">
<td>Establish: orotracheal/nasotracheal intubation<sup><a href="#notea">a</a></sup></td>
</tr>
<tr valign="top">
<td>Maintain: primary/secondary confirmation<sup><a href="#noteb">b</a></sup></td>
</tr>
<tr valign="top">
<td>Bypass: needle/surgical cricothyroidotomy</td>
</tr>
<tr valign="top">
<td scope="row" rowspan="4">Breathing/chest wall </td>
<td>Ventilation: chest rise/air entry/effort/rate</td>
</tr>
<tr valign="top">
<td>Oxygenation: central color/pulse oximetry</td>
</tr>
<tr valign="top">
<td>Support: distress&#8212;NRB/failure&#8212;BVM<sup><a href="#notec">c</a></sup></td>
</tr>
<tr valign="top">
<td>Chest wall: ensure integrity/expand lungs<br />
Tension pneumothorax: needle, chest tube<sup><a href="#noted">d</a></sup><br />
Open pneumothorax: occlude, chest tube<br />
Massive hemothorax: volume, chest tube</td>
</tr>
<tr valign="top">
<td scope="row" rowspan="4">Circulation/external bleeding</td>
<td> Stop bleeding: direct pressure, avoid clamps</td>
</tr>
<tr valign="top">
<td>Shock evaluation: pulse, skin CRT, LOC<sup><a href="#notee">e</a></sup></td>
</tr>
<tr valign="top">
<td>Blood pressure: avoid over/undercorrection<br />
Infant/child: low normal = 70 + (age &times; 2) mmHg<br />
Adolescent: low normal = 90 mmHg</td>
</tr>
<tr valign="top">
<td>Volume resuscitation: Ringer';s lactate &rarr; packed cells<br />
Infant/child: 20 mL/kg RL, repeat x 1-2 &rarr; 10 mL/PRBC<br />
Adolescent: 1-2l, repeat 1-2 &times; &rarr; 1-2 U PRBC</td>
</tr>
<tr valign="top">
<td scope="row" rowspan="4">Disability/mental status</td>
<td>Pupils: symmetry, reaction</td>
</tr>
<tr valign="top">
<td>LOC: GCS<br />
Track and trend as a vital sign<br />
Significant change = 2 points<br />
Intubate for coma = GCS &le;8</td>
</tr>
<tr valign="top">
<td>Motor: strength, symmetry</td>
</tr>
<tr valign="top">
<td>Abnormality or deterioration: call neurosurgeon<br />
Mild TBI (GCS 14-15): observe, consider CT for history of LOC<br />
Moderate TBI (GCS 9-13): admit, obtain CT, repeat CT 12-24 hr<br />
Severe TBI (GCS 3-8): intubate, ventilate, obtain CT, repeat CT 12-24
hr</td>
</tr>
<tr valign="top">
<td scope="row" rowspan="4">Exposure and environment</td>
<td> Remove clothing</td>
</tr>
<tr valign="top">
<td>Logroll: requires four people</td>
</tr>
<tr valign="top">
<td>Screening examination: front and back</td>
</tr>
<tr valign="top">
<td width="67%">Avoid hypothermia: keep patient warm</td>
</tr>
<tr valign="top">
<td colspan="2" scope="row"><strong><em>Adjuncts</em></strong></td>
</tr>
<tr valign="top">
<td scope="row">&nbsp;</td>
<td>Foley catheter unless contraindicated<sup><a href="#notef">f</a></sup></td>
</tr>
<tr valign="top">
<td scope="row">&nbsp;</td>
<td>Gastric tube unless contraindicated<sup><a href="#noteg">g</a></sup></td>
</tr>
<tr valign="top">
<td colspan="2" scope="row"><strong><em>Secondary Survey and Reevaluation</em></strong></td>
</tr>
<tr valign="top">
</tr><tr valign="top">
<td scope="row">&nbsp;</td>
<td>History and physical: SAMPLE history, complete examination</td>
</tr>
<tr valign="top">
<td scope="row">&nbsp;</td>
<td>Imaging studies: plain radiographs<sup><a href="#noteh">h</a></sup>, special studies<sup><a href="#notei">i</a></sup></td>
</tr>
</table>
<p class="size2"><a name="notea" id="notea"></a><sup>a</sup> RSI technique: etomidate then succinylcholine.<br />
<a name="noteb" id="noteb"></a><sup>b</sup> Primary: chest rise, air entry; secondary: exhaled CO2 detector, esophageal detector device; watch for DOPE: <strong>D</strong>islodgement, <strong>O</strong>bstruction, <strong>P</strong>neumothorax, <strong>E</strong>quipment failure.<br />
<a name="notec" id="notec"></a><sup>c</sup> NRB = nonrebreather mask; BVM = bag valve mask.<br />
<a name="noted" id="noted"></a><sup>d</sup> Do not wait for confirmatory chest x-ray.<br />
<a name="notee" id="notee"></a><sup>e</sup> CRT = capillary refill time, LOC = level of consciousness; consider obstructive and neurogenic as well as hypovolemic shock: exclude tension pneumothorax, cardiac tamponade, spinal shock.<br />
<a name="notef" id="notef"></a><sup>f</sup> Meatal blood, scrotal hematoma, high riding prostate.<br />
<a name="noteg" id="noteg"></a><sup>g</sup> Cerebrospinal fluid (CSF) oto/rhinorrhea, basilar skull fracture, midface instability.<br />
<a name="noteh" id="noteh"></a><sup>h</sup> Chest, pelvis, lateral cervical spine; others as indicated.<br />
<a name="notei" id="notei"></a><sup>i</sup> FAST, computer tomography (CT) scan as indicated.</p>
<p class="size2"><strong>Source:</strong> Adapted with permission from the American College of Surgeons Committee on Trauma, Advanced Trauma Life Support&reg; for Doctors Student Course Manual.</p>
<p class="size2"><a href="pedchap7b.htm#Tab7.3">Return to Document</a> </p>
<p>&nbsp;</p>
<div class="footnote">
<p> The information on this page is archived and provided for reference purposes only.</p></div>
<p>&nbsp;</p>
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