Trauma

TraumaMTP
No patient weight set. Open Pediatric Weight, Age, Height, or Length Tape to enable dose calculations.
Hypotension
Defined as Blood Pressure < 90/60 or MAP < 65–70.
IV Fluids (Crystalloid)
20 mL/kg
— mL

• Aggressive isotonic fluid resuscitation has been shown to worsen outcomes in trauma patients • Weight-based dose range: 10–30 mL/kg • Move to blood after 20–40 mL/kg

Hypertonic Saline (3%) IV/IO
• For use in severe traumatic brain injury or herniation, elevated ICP • Infuse over 20 minutes • Max dose: 300 mL • Fixed Dose: 250 mL over 10 minutes
Mannitol (20%) — Osmitrol IV/IO
• For severe traumatic brain injury, elevated ICP, signs of herniation • Infuse over 20–30 minutes • Watch for diuresis, hypotension • Weight-based dose range: 0.5–2 grams/kg • Repeat dose range based on response / clinical status: 0.25–1 gram/kg Q4–6 hours • Concentration: 20% (200 mg/mL)
Epinephrine Bolus (Push-dose)
Push-dose • Empty 1 mL from 10 mL saline flush • Draw up 1 mL of Cardiac dose (1 mg/10 mL, 1:10,000) • Mix with 9 mL NS → final concentration 10 mcg/mL • Administer 0.5–2 mL (5–20 mcg/dose) every 2–5 minutes PRN hypotension
Phenylephrine BOLUS IV/IO (Vazculep, Biorphen)
• Fixed Dose (Push-dose): 50–200 mcg/dose • Concentration: 100 mcg/mL (e.g., 50 mcg = 0.5 mL)
Tranexamic Acid (TXA) Loading Dose IV/IO — Cyklokapron
• Recommended to dose over 10 minutes • Max dose: 2 g • Fixed Dose Range: 1–2 grams • Concentration: 100 mg/mL (1 g = 10 mL)
Tranexamic Acid (TXA) Infusion IV/IO — Cyklokapron
• 1000 mg in 100 mL NS over 8 hours • Fixed Dose Infusion Rate: 125 mg/hr • Concentration: 100 mg/mL → 1.3 mL/hr
Massive transfusion (1:1:1)
pRBC—
FFP—
Platelets—
TXA load—
TXA infusion—
Pain / RSI

  • Analgesia/sedation

    IV
    Adult: 50-100 mcg IV
    IV slow push• 50 mcg/mL• 0.001 mg/kg

    1 mcg/kg = 0.001 mg/kg

  • Induction agent (esp. shock/asthma)

    IV
    Adult: 1-2 mg/kg IV
    IV push• 50 mg/mL• 2 mg/kg

  • Paralytic - non-depolarizing

    IV
    Adult: 1-1.2 mg/kg IV
    IV push• 10 mg/mL• 1.2 mg/kg

    1-1.2 mg/kg IV (1.2 mg/kg preferred for RSI). Onset 1-3 min, lasts 30 min.

Pediatric C-spine (PECARN)

Leonard et al. PECARN pediatric C-spine rule. If any factor is present → obtain C-spine imaging. If none are present → C-spine imaging not routinely indicated.

Imaging not routinely indicated
No high-risk factors selected. Clinical judgment still applies — re-evaluate if exam changes.

Reference: Leonard JC et al. Lancet Child Adolesc Health 2024 (PECARN pediatric C-spine prediction rule).