Trauma

Bicycle collision with vehicle — paediatric limb and abdominal trauma

Intermediate

Pediatric · 8yr · female

Patient Information

Dispatch	You are called to the First Aid Post at the Perth Royal Show. A bystander has carried in an 8-year-old girl who was struck by a slow-moving vehicle near the car park entrance. The child is crying and holding her left arm. (Mia Nguyen, DOB 14/03/2017)
Patient	Mia Nguyen — 8yr (25kg)
Incident History	Mia was riding her bike near the car park entry when a vehicle reversing out of a bay struck her. She was thrown off the bike onto the bitumen. Bystanders state she did not lose consciousness. She is complaining of left arm pain and stomach pain.
Emergency Contact	Linh Nguyen (Mother) — 0412 387 541

Initial Rapid Assessment

Response	Alert
Airway	Patent. Nil airway obstruction. Mia is crying and speaking in full sentences.
Breathing	Spontaneous, slightly elevated rate. Nil audible wheeze or stridor. Guarding noted with deep inspiration.
Circulation	Radial pulse present, slightly elevated, regular. Skin warm and pink. Superficial abrasions to left forearm and left knee. No active arterial bleeding. Left forearm visibly deformed mid-shaft.
Disability	GCS 15 (E4V5M6). Alert and oriented to time, place and person. Crying but appropriate.
Exposure	Left forearm mid-shaft deformity with overlying abrasion — no bone protrusion. Left upper quadrant abdominal tenderness on palpation with guarding. Superficial road rash to left knee and elbow. Helmet was worn — intact.

Vitals

Time	SpO2	Resp Dist	RR	Pulse	BP	CRT	GCS	PERL	Temp	BGL	Pain
Initial	98% (RA)	Mild	24	118	102/68	2s	15	3 3 ++	–	–	8
10 mins	99% (O2 NRB 10L)	Mild	20	124	98/64	2s	15	3 3 ++	–	–	6

History Taking

Treatment Response

Diagnosis

This patient is suffering from a suspected left mid-shaft forearm fracture (radius/ulna) and blunt abdominal trauma with left upper quadrant tenderness and guarding, consistent with possible solid organ injury — mechanism and abdominal findings make this a time-critical paediatric trauma patient.

Facilitator Triggers — if trainees miss a critical step

! (If abdominal tenderness and guarding are not identified during secondary survey within 5 minutes, Mia's HR rises to 132 and she begins to look pale and diaphoretic — facilitator to prompt 'She says her tummy is hurting more now.')
! (If oxygen is not applied within 3 minutes of initial assessment, SpO2 drops to 95% RA and Mia becomes more distressed with breathing.)
! (If the forearm is not immobilised and the limb is not assessed for distal neurovascular observations, facilitator states 'Mia says her fingers feel a bit tingly' — prompting neurovascular reassessment.)
! (If the significance of tachycardia in the context of abdominal guarding is not recognised and transport is not escalated, Mia's BP drops to 88/58 at 15 minutes — facilitator prompts 'She looks a bit pale, doesn't she?')
! (If secondary survey is skipped, facilitator states 'Mia keeps saying her tummy hurts when you touch near her ribs on the left side.')

Treatment Objectives

1. Ensure scene safety and don appropriate PPE.
2. Perform Primary Survey — Airway: patent, Mia speaking; Breathing: elevated RR with guarding, apply oxygen; Circulation: tachycardic, assess for haemorrhage; Disability: GCS 15; Exposure: identify forearm deformity and abdominal guarding.
3. Administer Oxygen via non-rebreather mask at 10–15 litres per minute — target SpO2 ≥95% for paediatrics.
4. Control active bleeding from abrasions with direct pressure using sterile dressings.
5. Perform full Vital Sign Survey — HR, RR, BP, SpO2, GCS, CRT, pain score.
6. Perform Secondary and CNS Survey — systematically palpate abdomen in all four quadrants; identify and document left upper quadrant tenderness and guarding (possible splenic/solid organ injury); assess left forearm for deformity, crepitus, and distal neurovascular observations (CRT, warmth, movement, sensation to fingers).
7. Immobilise left forearm mid-shaft suspected fracture using rigid splint or soft splint/pillow with broad bandages, securing above and below injury site; immobilise the joint above (elbow) and below (wrist); apply triangular bandage sling for additional support.
8. Reassess distal neurovascular observations after splinting — pulse, CRT, colour, warmth, movement and sensation to fingers.
9. Administer Methoxyflurane (Penthrox) via inhaler for pain management — 3 mL vaporised, patient self-administers intermittently; document pain score pre- and post-administration.
10. Recognise abdominal guarding + tachycardia in an 8-year-old as a RED FLAG for internal haemorrhage — treat as time-critical and escalate.
11. Apply paediatric vital sign thresholds: HR >140 in an 8-year-old is a major concern for decompensating haemorrhagic shock.
12. Do NOT leave patient unattended. Minimise on-scene time — this is a time-critical paediatric trauma patient.
13. Request ambulance support via State Operations Centre immediately given abdominal guarding and mechanism of injury.
14. Position patient supine for comfort and monitoring; do not walk the patient.
15. Record full observations every 10 minutes (or 5 minutes given time-critical status) — document all vital sign trends.
16. Apply Ready-Heat blanket or standard blanket to prevent hypothermia during transport.
17. Scenario ends on arrival of ambulance and IMISTAMBO handover.
18. Attention to hand hygiene will be given throughout the scenario.

Clinical references: Limb Trauma · Abdominal Trauma · Haemorrhage · Trauma Management Principles · Fractures & Dislocations · Secondary & CNS Survey · Primary Survey · Oxygen Delivery · Penthrox Inhaler Administration · Pain Assessment

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Signs/Symptoms	Left arm pain — severe. Left upper quadrant abdominal pain — moderate. Minor grazes to left knee and elbow.
Allergies	Nil known drug allergies.
Medications	Nil regular medications.
Pertinent History	Healthy 8-year-old girl. No significant past medical history. Helmet worn at time of incident.
Last Oral Intake	Ate a sausage sizzle and water approximately 1 hour prior.
Events Leading	Mia was riding her bicycle near the show car park exit lane when a reversing vehicle struck her left side. She was thrown from the bike to the bitumen. She did not hit her head and did not lose consciousness. She was helped to her feet by bystanders and carried to the FAP.
Treatment Prior	Nil. Bystander applied pressure to abrasion on knee with a cloth.

Onset	Acute — approximately 10 minutes prior to arrival at FAP following bicycle vs reversing vehicle collision.
Pain	Left mid-forearm — sharp, constant, 8/10. Left upper abdominal — dull, aching, worsens with movement and deep breath, 6/10.
Quality	Left arm — sharp, severe. Abdomen — dull, constant ache with guarding.
Radiates	Nil radiation reported.
Severity	8/10 forearm, 6/10 abdomen.