In this section
Breathing is a key priority in the Primary survey. It is essential to assess it with the potential life threats in mind. This chapter will describe how breathing differs in children, the causes of breathing problems in the paediatric age
group and their assessment and management.
(see how children are different section)
At the Royal Children's Hospital, once the trauma team has been activated, a senior anaesthetist should typically be allocated the role of the airway doctor. Typically an emergency department doctor will be allocated the role of the assessment doctor. The assessment and management of breathing in paediatric trauma will typically be jointed co-ordinated by these two team members. When a patient is spontaneously ventilating, the airway doctor will typically examine the nose, mouth and anterior neck, to assess for airway threats. The assessment doctor will then examine the chest of the patient - observing the chest, listening for breath sounds and feeling for crepitus / emphysema and tenderness. Where the patient is ventilated, the assessment doctor may still listen to the chest and report their findings to the group, but the airway doctor - by either hand ventilating the patient, or managing a ventilator - is responsible for the management of breathing. Regardless of how the patient is ventilating, the airway doctor throughout the primary survey is responsible for monitoring airway and breathing.
The life threats to identify and manage with regards to breathing include:
Respiratory distress is common in a severely injured child. Some of the causes include:
The assessment doctor will typically perform the initial assessment of the thorax during the primary survey. Their goal is to identify any immediate or impending life threats. The following components of the chest examination should be performed:
Expose the chest and look at:
Listen to the chest
Feel the chest for
If the anterior neck has not been examined by the airway doctor, ensure that it examined along with the chest. If there is concern for a cervical spine injury (as there is for most severe blunt trauma) then ensure manual in-line stabilisation is provided whilst opening the collar and examining the neck. The goal of the anterior neck injury is to exclude the following:
Airway Ensure is patent and protected (see airway management section)
If the airway is stable with or without an oropharngeal airway, and the patient requires breathing support, bag and mask ventilation, with a self-inflating bag, can be used.
Reassess whilst using bag and mask ventilation. If there is any further inadequacy, consider intubation. See below
Bag and mask ventilation
Sizes of bags
For tracheal intubation
(see airway management section)
See breathing procedures section for detailed technique for using a bag-valve-mask.
chest injury section for the management of the following;