FIELD REFERENCE
Full criteria & treatment guidance
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 correct analgesia pathway and account for every dose already given.
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. Target SpO₂ above 90% and ETCO₂ 35–45 mmHg where possible, with airway repositioning or 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; follow the TBI fluid and repeat instructions. 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 and consistent with destination direction.
VISUAL FIELD REFERENCE
Pediatric TBI: monitor three linked targets
Pediatric · ALS
Suspected TBI branch. Do not substitute the hemorrhage fluid-repeat instructions.
- SpO₂ >90% · ETCO₂ 35–45
Oxygenation & ventilation
Continuously monitor SpO₂ and ETCO₂. Target SpO₂ above 90% and ETCO₂ 35–45 mmHg where possible, with airway repositioning or BVM escalation when oxygen alone is insufficient.
- Recheck every 5 minutes
Age-specific systolic BP
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; follow the TBI fluid and repeat instructions. Assess GCS, using pediatric GCS at age 2 or younger.
Trauma destination
Transport to a trauma center, preferably a Level 1 or 2 pediatric trauma center when possible and consistent with destination direction.
- The TBI section has different fluid-repeat wording from the hemorrhage section; do not merge them into a single universal rule.
Selected checkpoints; read the complete guide for criteria, exclusions, doses, and ongoing care. SO-P-015
UNDERSTAND THE CARE
Why trauma reassessment needs separate bleeding and neurologic tracks
External bleeding control and transport preparation occur alongside evaluation for brain injury and poor perfusion. Record the mechanism, weight, consciousness and distal examination where relevant. A successful dressing or tourniquet addresses one problem and does not finish the trauma assessment.
Applying the guidance
The hemorrhage and TBI sections contain different instructions. Keep the child’s age visible when applying head-injury pressure targets, and trend oxygenation, ventilation and neurologic findings. For painful isolated injury, record the selected analgesic, prior treatment and response while retaining the age-specific base-contact requirement.
Putting it together
Teaching example: bleeding is controlled but consciousness worsens. Continue the TBI assessment and its oxygenation, ventilation and pressure targets, and report the neurologic trend rather than describing the case only as controlled hemorrhage.
Diagram text & teaching checkpoints
- Hemorrhage
- Control bleeding and record device times.
- Perfusion
- Use the applicable pediatric fluid branch.
- Neurologic status
- Age-specific TBI targets and serial findings.
- Handoff
- Mechanism, trends, treatment and destination.
Sources for this explanation
Original OCMedic teaching synthesis of the references below. Educational expansion updated ; this is not a new independent clinical-review date. Source-specific dates and limitations remain in the full guidance.