* Clinicians should always perform actions in RED.
• Administer 20 mL/kg of warmed normal saline or Ringer's lactate over 10 to 20 minutes.
Δ Signs of herniation include coma, unilateral pupillary dilation with outward eye deviation followed by hemiplegia, hyperventilation, Cheyne-Stokes respirations, and/or decerebrate or decorticate posturing.
The initial management of children with suspected intraabdominal injury (IAI) should adhere to the Advanced Trauma Life Support guidelines for diagnosis and treatment of immediately life-threatening injuries (figure 1). (See "Trauma management: Approach to the unstable child", section on 'Initial approach'.)
During stabilization, children with signs of IAI and hemodynamic instability that do not respond to fluid resuscitation and blood transfusion warrant emergent laparotomy. (See 'Laparotomy' below.)
After the patient has been assessed, resuscitated, and stabilized, the patient should receive ongoing care directed by a pediatric surgeon with trauma expertise, whenever possible. Because optimal care and outcomes occur when the critically injured child is initially resuscitated and subsequently managed in a pediatric trauma center (PTC), it is preferable to provide initial care in such facilities from the outset, whenever possible, or to arrange transfer to a PTC for ongoing management. (See "Trauma management: Approach to the unstable child", section on 'Definitive care'.)
UPDATE