ECMO-/ECLS

It is important to obtain as much of the prehospital information as
possible. Aside from the vital signs and patient’s condition, facts about the
scene of the trauma and mechanism of injury should be elicited. For instance,
in a motor vehicle crash, the use of restraining devices (seat belts, car seats),
the patient’s location within the vehicle, damage to the vehicle, extraction
methods utilized, and any fatalities in the scene give the cinician a sense of the
severity of the MVC. In cases of falls, knowledge regarding the height from
which the child has fallen and the surface where he landed lends a sense of the
force of impact that he may have sustained. A quick summary of the child’s
past medical history, allergies, medications, and last meal should be elicited
from pre-hospital medical personnel
The evaluation of the abdomen during trauma can occur during the
primary or secondary survey, depending on the mechanism of injury and the
known injuries sustained. Once in the trauma bay, findings on physical exam
may give clues as to potential intra-abdominal injuries. Findings such as
abdominal contusions or abrasions, tenderness, distention, or a “seat belt sign”
or “handle bar mark” may indicate the presence of abdominal injuries.
In a patient with suspected abdominal injuries, a complete blood count
and a metabolic panel are typically obtained. In a stable patient, elevation of
AST or ALT beyond 250 mg/dL may prompt a CT scan to look for occult hepatic
injury (Oldham). Amylase and lipase are often sent, but some investigators
argue that they are reliable or cost effective screening tools [10]. In children
with suspected non-accidental trauma, elevations in AST or ALT, or abnormal