When There Are No Inpatient Beds: Providing Pediatric Critical Care for Trauma Patients in the Emergency Department

The continued growth in emergency department (ED) use combined with limited inpatient bed availability often leads to boarding of patients needing inpatient or intensive care unit admission in the ED. Emergency department personnel are experienced in the rapid assessment of trauma patients but may be less prepared or comfortable with providing ongoing management of trauma patients, especially critically injured pediatric patients. This article reviews management principles of traumatic brain injury, mechanical ventilation, and shock in the pediatric trauma patient and is intended to guide ED management of these patients until they can be transferred to an appropriate level of inpatient care.