›Balanced warmed fluids for initial resuscitation local protocol dependent
›Early blood products for hemorrhagic shock local protocol dependent
Hemorrhage control and transfusion
›Bleeding control
›Direct pressure and tourniquet when appropriate
›Pelvic binder for suspected unstable pelvic fracture with shock
›Tranexamic acid local protocol dependent
›15 mg per kg IV loading dose
›Maximum 1000 mg loading dose
›Infusion 2 mg per kg per hour for 8 hours
Airway and ventilation strategy
›Airway plan
›Anticipated difficult airway features
›C spine protection during airway management
›RSI medication selection local protocol dependent
Diagnostic sequencing and reassessment loop
›Reassessment loop
›Repeat vitals every 5 to 15 minutes in unstable patient
›Repeat neuro checks at defined intervals
›Repeat exam after analgesia
›Repeat FAST if evolving shock local protocol dependent
Consultations
›Consultation triggers
›Trauma surgery
›Neurosurgery for intracranial injury
›Orthopedics for open fracture or neurovascular compromise
›Child protection team for non accidental trauma concern
›Transfer center for higher level pediatric trauma care
17Disposition/dispo27
Level of care criteria
›ICU level care
›Ongoing respiratory support
›Persistent shock or vasopressors
›Severe traumatic brain injury
›Ongoing bleeding requiring transfusion
›Inpatient admission
›Moderate traumatic brain injury
›Solid organ injury requiring observation
›Uncontrolled pain requiring IV opioids
›High risk fractures needing operative management
Observation pathway
›ED or short stay observation
›Intermediate risk head injury with serial neuro checks
›Persistent vomiting with normal neuro exam
›Abdominal pain with reassuring initial evaluation
Transfer criteria
›Transfer to pediatric trauma center
›Airway intervention requirement
›Suspected intracranial hemorrhage
›Unstable thoracic injury
›Hemorrhagic shock
›Complex multisystem trauma
Discharge criteria
›Safe discharge features
›Normal mental status baseline
›Stable vitals for age
›Pain controlled on oral medications
›Normal neurovascular exam distal to injury
›Reliable caregiver observation
›Clear return precautions understood
18Discharge Instructions/di28
Copy discharge instructions
›Summary
›Injury evaluation today did not show life threatening injuries
›Symptoms can change in the next 24 to 48 hours
›Medications
›Acetaminophen as directed for pain
›Ibuprofen as directed for pain if no kidney disease and no bleeding risk
›Avoid aspirin unless prescribed
›Activity
›No sports or high risk activity until cleared if head injury symptoms
›Splint or sling use as directed if provided
›Elevation and ice for swelling in first 24 to 48 hours
›Follow up
›Primary care or clinic follow up in 1 to 3 days
›Fracture clinic follow up timing as instructed
›Concussion follow up if symptoms persist beyond 48 hours
›Return to emergency care now
›Increasing sleepiness or hard to wake
›Worsening headache
›Repeated vomiting
›Confusion or behavior change
›Seizure
›Weakness or numbness
›Trouble breathing
›Chest pain
›Abdominal pain worsening
›Fainting
›Bleeding that will not stop
›Blue or cold fingers or toes beyond an injury
19References/r8
Guidelines and decision tools
›Evidence sources
›American College of Surgeons ATLS Student Course Manual 2023
›Advanced Trauma Life Support for Doctors ATLS 10th edition 2018
›Pediatric Advanced Life Support PALS Provider Manual 2020
›PECARN head trauma clinical decision rule study 2009
›PECARN blunt abdominal trauma prediction rule study 2013
›NICE head injury assessment and early management guideline 2023
›EAST trauma practice management guidelines pediatric trauma topics various years local protocol dependent
Evidence & Review
Reviewed by SymptomDx Medical Team·Last reviewed
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.