# Pediatric injury / trauma

Control hemorrhage, reassess perfusion, and keep pediatric analgesia and head-injury targets distinct.

Population: Pediatric. Scope: ALS.
Status: published. Source-linked OCEMS summary.
Summary updated: 2026-09-16.
Source checked: 2026-09-16.
Source version: See the linked OCEMS source for revision and implementation dates..
Canonical page: https://www.ocmedic.com/guides/pediatric-trauma/
Official source: [SO-P-015 — General Injury and Trauma - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2024-03/SO-P-15%20Peds%20Injury%204-2024_0.pdf)

Independent OC Medic summary. Does not replace the complete policy, current system notices, or clinical judgment.

## Key cautions & base contact

- The TBI section has different fluid-repeat wording from the hemorrhage section; do not merge them into a single universal rule.
- Confirm the source pathway and account for all prior analgesic doses.

## Source documents

- [SO-P-015 — General Injury and Trauma - Pediatric](https://www.ochealthinfo.com/sites/healthcare/files/2024-03/SO-P-15%20Peds%20Injury%204-2024_0.pdf)

## Bleeding control

- Apply direct pressure. If controlled, secure a pressure dressing. For persistent bleeding, consider a hemostatic dressing with direct pressure.
- For uncontrolled extremity bleeding despite these measures, apply a tourniquet under the relevant procedure. Begin transport promptly when hypotension or serious injury is present.

## Perfusion and triage

- For hypotension, establish IV/IO and give saline 20 mL/kg, maximum 250 mL per bolus, with base contact. The hemorrhage pathway allows two repeats for three total boluses.
- Base contact is required for hypotensive hemorrhage and patients meeting trauma-triage criteria; a pediatric-capable base is preferred.

## Pain and isolated injury

- For severe pain in the listed eye, extremity, or impaled-object pathways: morphine 0.1 mg/kg IV/IM, maximum 5 mg, OR fentanyl 2 mcg/kg IN/IV/IM, maximum 50 mcg. May repeat once after 3 minutes; total limits 10 mg morphine or 100 mcg fentanyl.
- Base contact is required at age 2 or younger. Splint as appropriate, document distal pulse/sensation, and protect an injured eye without globe pressure. Do not remove face/neck impaled objects unless breathing is compromised.

## Suspected TBI

- Continuously monitor SpO₂ and ETCO₂. The source targets SpO₂ above 90% and ETCO₂ 35–45 mmHg where possible, with airway repositioning/BVM escalation when oxygen alone is insufficient.
- Recheck systolic BP every 5 minutes. TBI targets are above 70 + 2 × age for ages 0–9 and above 90 for age 10 and older; use the TBI-specific fluid and repeat instructions in the source. Assess GCS, using pediatric GCS at age 2 or younger.
- Transport to a trauma center, preferably a Level 1 or 2 pediatric trauma center when possible under source/destination direction.