[Polytraumatised children].

Abstract

Trauma is the leading cause of mortality in children between the ages of 1 and 14 years. It represents a major health problem in all industrialized countries. A well coordinated organization of the whole chain of cares is essential, from the initial management at the scene of the accident until the long term neurological rehabilitation of the child. During the initial examination, the presence of anoxia, hypovolemia or neurological distress was systematically evaluated. Emergency therapeutic measures should be ensured. At the term of this initial management: if the haemodynamic state is unstable, an emergency operative procedure may be required; if the haemodynamic state remains stable, one can realize a complete clinical and radiological assessment. The clinical and biological supervision must continue during this evaluation while sedation and analgesia are essential to limit an increase in intracranial pressure (ICP). At the term of this complete assessment, if one or several surgical lesions are identified, an operative program with a precise hierarchy is scheduled; if an intensive medical support is required, the child is then transferred to the pediatric intensive care unit. Most often, children with a serious head trauma do not have neurosurgical lesions but a "brain-swelling" or cerebral edema. Elevated ICP is one of the main risk for cerebral ischemia. Therefore, continuous assessment of ICP is essential. Thoracic trauma is most often a closed trauma in the child: pneumothorax and pulmonary contusion are the problems most frequently met. An emergency laparotomy is required if the abdomen volume increases rapidly associated to the persistence of a unstable haemodynamic status despite an important fluid expansion. However, the presence of intraperitoneal blood is no longer a formal indication to surgery. Frequent examination of liver and splenic lesions with abdominal tomodensitometry allows to avoid surgery in more than 90% of cases at the price of a very rigorous haemodynamic supervision. Intestinal perforations are rare and difficult to diagnose: peritoneal dialysis, if it reveals the presence of a leucocytosis greater than 500/mm3 or bacteria justifies the surgery.(ABSTRACT TRUNCATED AT 400 WORDS)