Pediatric Trauma Care
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Current Topics in Pediatric Trauma Care (Trauma CME)

This resource combines audio and digital components to review three topics in pediatric trauma care: concussion/mTBI, blunt abdominal trauma, and diagnostic POCUS. Includes 12 AMA PRA Category 1 Credits™, including 12 Trauma credits.

Modules

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Authors

Susan B. Kirelik, MD, FAAP
Medical Director, Rocky Mountain Pediatric OrthoONE Center for Concussion; Attending Pediatric Emergency Physician, Rocky Mountain Hospital for Children, Denver, CO
Nicole Schacherer, MD
Assistant Professor of Pediatrics, Eastern Virginia Medical School, Department of Pediatric Emergency Medicine, Children’s Hospital of The King’s Daughters, Norfolk, VA
Jill Miller, MD
Associate Professor of Pediatrics, Eastern Virginia Medical School, Department of Pediatric Emergency Medicine, Children’s Hospital of The King’s Daughters, Norfolk, VA
Kelli Petronis, MD
Assistant Professor of Pediatrics, Eastern Virginia Medical School, Department of Pediatric Emergency Medicine, Children’s Hospital of The King’s Daughters, Norfolk, VA
Joshua Guttman, MD, FRCPC, FAAEM
Assistant Professor, Ultrasound Fellowship Director, Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA
Bret P. Nelson, MD, RDMS, FACEP
Director, Emergency Ultrasound, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY

Peer Reviewers

Jeffrey J. Bazarian, MD, MPH
Professor of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY
Tamara R. Espinoza, MD, MPH, FACEP
Co-Chair, Traumatic Brain Injury Task Force, Injury Prevention Research Center at Emory; Assistant Professor, Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA
Lara Zibners, MD, MMed, FAAP, FACEP
Honorary Consultant, Paediatric Emergency Medicine, St. Mary’s Hospital Imperial College Trust, London, UK; National Educator, ATLS UK, Royal College of Surgeons, London, UK; Nonclinical Instructor of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
Delia L. Gold, MD
Assistant Professor of Pediatrics, Division of Emergency Medicine, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH
Thomas Mailhot, MD
Associate Professor of Clinical Emergency Medicine, Keck School of Medicine of USC, Emergency Ultrasound Division Chief, Los Angeles County + USC Medical Center, Los Angeles, CA

Podcast Presenter

Susan B. Kirelik, MD, FAAP
Medical Director, Rocky Mountain Pediatric OrthoONE Center for Concussion; Attending Pediatric Emergency Physician, Rocky Mountain Hospital for Children, Denver, CO

Table of Contents

Course 1: Concussion in the Emergency Department: A Review of Current Guidelines + EMplify podcast audio summary

  1. Key Points
  2. Abstract
  3. Introduction
  4. Concussion in Sport Group Consensus Statement
    1. Definition of Concussion
    2. Sideline Assessment
    3. Concussion Management and Recovery Timeframe
    4. Return to Sport
    5. Complications of Concussion
    6. Concussion Prevention
  5. United States Centers for Disease Control and Prevention Pediatric Mild Traumatic Brain Injury Guideline
  6. Beyond the Guidelines: Practical Concussion Management Recommendations for the Emergency Clinician
    1. Initial Evaluation and Diagnosis
    2. Emergency Department Management
    3. Aftercare
    4. Follow-Up Care
    5. Clearance From Concussion in the Emergency Department
  7. Summary
  8. Additional Resources
    1. Tools
    2. Video demonstrating the administration of the VOMS
    3. Video demonstrating the Balance Error Scoring System
    4. Podcast
  9. Tables and Figures
    1. Table 1. Concussion in Sport Group Consensus Statement Definition of Sport-Related Concussion
    2. Table 2. Graduated Return-to-School Strategy
    3. Table 3. Graduated Return-to-Sport Strategy
    4. Table 4. Canadian CT Head Injury Rule
    5. Table 5. Differential Diagnosis of Concussion
    6. Table 6. Signs and Symptoms of Concussion
    7. Table 7. Proper Sleep Hygiene Techniques
    8. Figure 1. PECARN Decision Rule for Patients Aged < 2 Years
    9. Figure 2. PECARN Decision Rule for Patients Aged ≥ 2 Years
  10. References

Course 2: Pediatric Blunt Abdominal Trauma: Recognition and Management in the Emergency Department

  1. Key Points
  2. Abstract
  3. Case Presentations
  4. Introduction
  5. Critical Appraisal of the Literature
  6. Epidemiology and Pathophysiology
    1. Epidemiology
    2. Etiology and Pathophysiology
  7. Common Mechanisms of Injury in Blunt Abdominal Trauma
    1. Motor Vehicle Crashes
      1. Seat-Belt Syndrome
    2. Pedestrian Struck By Motor Vehicle
    3. Falls
    4. Bicycle Injuries
    5. Sports Injuries
    6. Nonaccidental Trauma
  8. Prehospital Care
  9. Emergency Department Evaluation
    1. Primary Survey
    2. Focused History
    3. Secondary Survey
      1. Physical Examination Findings Suggestive of Abdominal Injury
  10. Diagnostic Studies
    1. Laboratory Tests
    2. Focused Assessment With Sonography in Trauma
    3. Computed Tomography
      1. Risks of Computed Tomography in Pediatric Patients
      2. Determining Which Patients Do Not Need Computed Tomography
  11. Treatment
    1. Initial Management
    2. Management of Specific Organ Injuries
      1. Splenic Trauma
        • Diagnosis
        • Management
      2. Liver Trauma
        • Diagnosis
        • Management
      3. Renal Trauma
        • Diagnosis
        • Management
      4. Pancreatic Trauma
        • Diagnosis
        • Management
      5. Gastrointestinal Trauma
        • Diagnosis
        • Management
      6. Adrenal Trauma
  12. Special Populations/Circumstances
    1. Nonaccidental Trauma
    2. Obesity
    3. Postmenarchal Females/Pregnancy
  13. Controversies and Cutting Edge
    1. Massive Transfusion Protocols
    2. Thromboembolization
    3. Contrast-Enhanced Ultrasound
    4. Decreased Time on Bed Rest
    5. Pediatric Shock Index
  14. Disposition
  15. Summary
  16. Time- and Cost-Effective Strategies
  17. Risk Management Pitfalls in Blunt Abdominal Trauma in Pediatric Patients
  18. Case Conclusions
  19. Clinical Pathway for Management of the Pediatric Patient With Blunt Abdominal Trauma
  20. Figure
    1. Figure 1. Seat-Belt Sign
  21. References

Course 3: Diagnostic Point-of-Care Ultrasound: Assessment Techniques for the Pediatric Trauma Patient

  1. Abstract
  2. Introduction
  3. Critical Appraisal of the Literature
  4. Prehospital Ultrasound
  5. Emergency Department Assessment Using Ultrasound
    1. FAST Examination
      1. Future Applications
    2. E-FAST Examination
      1. E-FAST to Detect Pneumothorax
      2. E-FAST to Detect Hemothorax
    3. Assessment for Skull Fractures
      1. Technique
      2. Future Applications
    4. Update: Assessment for Forearm Fractures
      1. Technique
      2. Future Applications
    5. Lung Ultrasound
      1. Technique
    6. Cardiac Ultrasound
      1. Technique
        • Subxiphoid View
        • Apical 4-Chamber View
        • Parasternal Long-Axis View
        • Parasternal Short-Axis View
        • Other Cardiac Views
      2. Indications for Cardiac Ultrasound
        • Pericardial Effusion and Tamponade
        • Assessment of Left Ventricular Ejection Fraction
        • Cardiac Arrest
    7. Assessment of Intravascular Volume
      1. Technique
      2. Future Applications
    8. Assessment for Testicular Torsion
      1. Technique
  6. Controversies and Cutting Edge
  7. Summary
  8. Acknowledgement
  9. Editor’s Note
  10. Figures
    1. Figure 1. Right Upper Quadrant View in the FAST Examination
    2. Figure 2. Left Upper Quadrant View in the FAST Examination
    3. Figure 3. Pelvic View in the FAST Examination
    4. Figure 4. Subxiphoid Cardiac View in the FAST Examination
    5. Figure 5. Lung View in the E-FAST Examination for Assessment of Pneumothorax
    6. Figure 6. Skull Fracture on Ultrasound
    7. Figure 7. Transducer Placement for Posteroanterior View
    8. Figure 8. Transducer Placement for Anteroposterior View
    9. Figure 9. Transducer Placement for Lateral View
    10. Figure 10. Nondisplaced Radius Fracture
    11. Figure 11. Minimally Displaced Radius Fracture
    12. Figure 12. Significantly Displaced Radius Fracture
    13. Figure 13. Buckle Fracture of the Distal Radius
    14. Figure 14. Wrist Joint
    15. Figure 15. Cardiac Ultrasound in the Subxiphoid View
    16. Figure 16. Cardiac Ultrasound in the Apical 4-Chamber View
    17. Figure 17. Cardiac Ultrasound in the Parasternal Long-Axis View
    18. Figure 18. Cardiac Ultrasound in the Parasternal Short-Axis View, Mitral Valve Level, in the Cardiology Orientation
    19. Figure 19. Pericardial Effusion Seen Through the Subxiphoid Window
    20. Figure 20. Pericardial Effusion Seen Through the Parasternal Long-Axis View
    21. Figure 21. Inferior Vena Cava in the Long Axis
    22. Figure 22. Inferior Vena Cava and Aorta in the Short Axis
  11. Videos
    1. Ultrasound assessment of the peritoneum for free fluid
    2. Tutorial on performing the E-FAST examination on pediatric patients
    3. Tutorial on performing focused cardiac ultrasound on pediatric patients
  12. References
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