Emergency Department Management of Pediatric Blunt Thoracic Injuries - Trauma EXTRA Supplement (Trauma CME)

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Publication Date: November 2023 (Volume 20, Supplement 11)

CME Credits: 4 AMA PRA Category 1 Credits™ and 4 AOA Category 2-B CME credits. CME expires 11/15/2026.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma credits, subject to your state and institutional approval.

Authors

Glenn Goodwin, DO

Attending Physician, Emergency Medicine Residency Program, HCA Florida Aventura Hospital, Aventura, FL

Moshe Bengio, DO, MS, EMT-P

Emergency Medicine, HCA Florida Aventura Hospital, Aventura, FL

Christian B. Ryckeley, MD

Emergency Medicine, HCA Florida Aventura Hospital, Aventura, FL

Michelle N. Marin, MD

Attending Physician, HCA Palms West Hospital, Division of Pediatric Emergency Medicine, Loxahatchee, FL

Peer Reviewers

Stuart Bradin, DO, FAAP, FACEP

Professor, Department Emergency Medicine, Division of Pediatric Emergency Medicine; Professor, Department of Pediatrics; Assistant Medical Director of Pediatric Patients, Survival Flight; University of Michigan Medical School, Ann Arbor, MI

Paula J. Whiteman, MD, FACEP, FAAP

Associate Professor, Department of Emergency Medicine, Cedars-Sinai, Los Angeles, CA

Abstract

Pediatric chest trauma can present with a wide array of symptoms and with varying rates of morbidity and mortality. Children have unique thoracic anatomical and physiological characteristics, often necessitating diagnostic and management considerations that differ from management of blunt chest injury in adults. This review discusses diagnostic and treatment modalities for commonly encountered injuries in pediatric blunt thoracic trauma, such as pulmonary contusions, rib fractures, pneumothoraces, and hemothoraces. Rarely encountered but high-mortality injuries, including blunt cardiac injury, commotio cordis, tracheobronchial injury, and aortic injury, are also discussed.

Case Presentations

CASE 1

A 4-year-old boy who was involved in a high-speed MVC has arrived at your ED via EMS…

He was an unrestrained passenger in the collision and was ejected from the vehicle.
EMS was unable to assess breath sounds on their arrival due to the commotion on scene.
The patient is tachycardic, with a heart rate >130 beats/min, pallor, and diaphoresis.
His other vital signs include: blood pressure, 68/49 mm Hg; respiratory rate, 40 breaths/min; and oxygen saturation, 92% on 100% oxygen via nonrebreather.
He is tachypneic with absent breath sounds on the right side.
You wonder if you should proceed with immediate intervention or wait for confirmatory imaging…

CASE 2

A 5-year-old girl arrives via EMS after being hit by a car while riding her bicycle on the sidewalk…

The same high-speed MVC that injured your first patient caused another car to veer off the road and hit this girl.
EMS reports that she has a “swollen neck and chest.”
She is mildly tachycardic, with a heart rate of 120 beats/min, and hypoxic, with oxygen saturation of 81% on room air.
You consider the best next steps in evaluating and treating this patient...

CASE 3

A 16-year-old boy arrives via EMS in cardiac arrest…

The patient was pitching in a high school baseball game and collapsed after a line-drive ball hit him in the chest.
CPR was initiated at the scene by the paramedics.
He is in ventricular fibrillation on arrival at the ED.
You recognize that time is of the essence for this patient and quickly consider the options…

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.