Suspected vascular injury clinical care pathway

Objectives

Pathway for Suspected / high risk of Vascular Injury in Paediatric Trauma

If a paediatric patient presents to Paediatric Emergency Department (ED) in RHC-G with suspected or high risk of vascular trauma/significant risk of vascular injury, the following clinical teams should be contacted:

Vascular injury to lower or upper limbs

• Plastic surgery should be the first point of contact
• Depending on the nature of injury, plastic surgery may choose to involve vascular surgery if they feel appropriate (note that the patient will be admitted under plastic surgery)
• Plastic surgical registrar can be contacted via RHC-G switchboard – note that they are not always on-site
• Vascular surgery team will be contacted if required after review by plastic surgery

Vascular injury torso

• Paediatric general surgery should be the first point of contact
• If it is obvious that the vascular injury involves the heart, great vessels or neck, then cardiothoracics should be called also
• Vascular surgery will be called if either of the above teams feel that this is required
• If associated code red major haemorrhage or cardiac arrest please follow ‘advanced trauma call’ protocol

Orthopaedics involvement

• Paediatric orthopaedic surgeons should be phoned if the vascular injury involves joint or bone in addition to the above

Vascular injury is often associated with significant haemorrhage so the patient may require activation of major haemorrhage protocol and tranexamic acid (15mg/kg).