Lucknow docs craft comprehensive guide for paediatric trauma care
Touted as SE Asia’s first, the manual, that is being shared with doctors across the country, is a ready reckoner on handling queries related to trauma cases in children
How do you make a two-year old baby lie down after a major injury?
If you think the answer is to make the baby lie on ‘straight bed or a cot’ with a pillow for head support, then you are wrong as it will compromise the child’s breathing.
The correct thing to do is to ensure that the child’s head is kept straight, and a thin pillow or mattress be placed beneath the shoulder to give the neck region more space to breathe.
Such and more queries would be addressed in the Paediatric Trauma Resuscitation Manual (PTRM) developed by Lucknow doctors. It has been compiled by prof Samir Misra, senior faculty trauma surgery department of the King George’s Medical University (KGMU) and Dr Neha Thakur (Rai) of the paediatric department at the Ram Manohar Lohia Institute of Medical Science in Lucknow.
The PRTM is southeast Asia’s first child injury manual and contains details of the many significant points that a person needs to know while handling paediatric trauma cases.
“This is first such guidebook on paediatric trauma cases in South East Asia. The need was felt because children cannot correctly locate or describe the site of pain and level of injury, making diagnosis and treatment more difficult, he said.
Professor Samir said the PRTM describes all about paediatric airway management that is crucial to allow normal breathing in an injured child, how to take x-rays, manage fractures and even understand bone fracture in an injured child. It also talks about how to administer fluid to a child if the doctors aren’t getting the vein in a child in trauma.
Professor Samir said cases of child trauma are markedly different from adult trauma ones.
“In adult trauma cases, even half a litre of blood loss puts the people in a compromised situation but in case of children, even 100-ml blood loss could be risky,” he said.
“Similarly, in burn injury, the calculation for administering fluid also changes for children. In an adult the entire head is estimated as 9% of the entire body but in children it is 18 to 21 percent of the body. That’s why when calculating fluid transfusion in a child this percentage should be kept in mind,” he said.
“Doctors often take gap in bone of an injured child as fracture. A child is born with more bones that gradually fuse with age. In a child this gap might appear as a fracture and if this is operated for union of the bone it will hamper growth of the child,” he said.
“Similarly, a child is not a small adult. Hence a child cannot be treated upon reduced calculations based upon adult. What this means is that you can’t just give half a tablet of paracetamol to a child just because you feel child is half the age and weight of an adult,” he said.
The PRTM was prepared after approval from Indian Council of Medical Research (ICMR) and Professor Samir said they got a questionnaire filled by over 700-respondents from across India, comprising doctors, para-medical staff on attending emergency cases. “We asked how confident they were while handling an injured child. Based upon the responses, we collaborated with experts from across globe to help us put together a step-by-step guide in child trauma cases,” he said.
“We have conducted training of trainers (ToT) sessions at a few places and soon we will hold sessions in Jodhpur, Goa, Mumbai, Guwahati,” he said.
The module, he said, will be shared across India as advanced trauma life support (ATLS) course has trained medical staff on handling trauma (adult) cases.
Dr Neha Thakur (Rai) of the paediatric department at the Ram Manohar Lohia Institute of Medical Science is among Lucknow doctors who have developed PRTM.
“The entire PTRM manual has been conceptualized by Lucknow doctors and that it is Southeast Asia’s first manual speaks volumes on all aspects of handling a paediatric trauma case,” said Dr Neha, among the initiators of paediatric trauma care in India. Others associated with PRTM include Prashant Mahajan from US, who works on implementation of new medical modules and Jabeen Fayyaz from Canada, an expert in compiling modules.