Management of Multiply Injured Pediatric Trauma Patients in the Emergency Department -

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Andria Tatem, MD

Chief Resident, Department of Pediatrics, Instructor, Eastern Virginia Medical School Children’s Hospital of The King’s Daughters, Norfolk, VA

 

Rupa Kapoor, MD, FAAP

Assistant Professor, Eastern Virginia Medical School, Norfolk, VA

 

Peer Reviewers

 

Michelle Hughes, DO, FAAP

Pediatric Emergency Medicine Attending, Associate Medical Director for Trauma, Children’s Hospital of the King’s Daughters, Assistant Professor of Pediatrics, Eastern Virginia Medical School, Norfolk, VA

 

Lara Zibners, MD, MMEd

Honorary Consultant, Paediatric Emergency Medicine, St. Mary’s Hospital Imperial College Trust, London, UK; Nonclinical Instructor of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY

 

Abstract

Management of the child with multiple traumatic injuries can be challenging, and important injuries may not be readily recognized. Early recognition of serious injuries, initiation of appropriate diagnostic studies, and rapid stabilization of injuries are key to decreasing morbidity and mortality in the multiply injured pediatric trauma patient. The differential diagnosis for these patients is wide, and treatment is targeted to the specific injuries. In this issue, a systematic approach to the multiply injured pediatric patient will be reviewed, with specific attention to commonly missed injuries and those injuries that may cause significant morbidity or mortality.

Excerpt From This Issue

A 12-year-old previously healthy boy presents to the ED via EMS for a visible deformity of his right arm. His 18-year-old brother was pulling him around in an inner tube that was attached by a long rope to a truck traveling about 40 miles per hour through a lightly wooded area. His brother made a sharp turn, and the patient went flying off the inner tube and hit a tree. The brother said that the patient did not lose consciousness, but that he was “stunned” for a few seconds, then started complaining about his right arm. The patient said he was not wearing any personal protective equipment. He has multiple abrasions to his face, trunk, and extremities. He denies pain anywhere except in his arm. He requests to have his neck brace removed because it is “annoying.” He denies vomiting but reports feeling nauseous after receiving morphine from the paramedics en route to the hospital. Because this was a severe mechanism, though the patient appears to have an isolated injury, you begin to consider how much you should do. Should you “pan-scan” the patient and draw labs because of the mechanism? What other imaging studies do you need to obtain besides an x-ray of the arm? Is the patient at risk for internal bleeding due to this blunt impact? Should you consult the surgeons or just call the orthopedist to reduce the obvious fracture?