From
StayCurrentMD
Update Course Rewind: Preparing for Penetrating Trauma 2022
With Dr. Bindi Makharia
Chapter 1 of 3 · Fundamentals
Trauma epidemic
Introduction to Pediatric Penetrating Trauma Epidemic
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
ATLS is focused on blunt trauma and there's not as much teaching for penetrating trauma
Time is of the essence in penetrating trauma management
You want to get these children to the operating room as quickly as possible
There's a much higher likelihood of rapid massive bleeding in penetrating trauma
Penetrating trauma has higher likelihood of needing an OR, chest tube or ED thoracotomy
Potential injuries in penetrating trauma are directly determined by bullet trajectory
Quick x-rays are very helpful in penetrating trauma to determine bullet trajectory
For airway in penetrating trauma, try not to intubate until absolutely necessary and save for the OR in case they're hypotensive
For chest gunshot wound, place the chest tube on the injured side
Activate the massive transfusion protocol for circulation management in penetrating trauma with extremity injury
Disability assessment in penetrating trauma doesn't matter unless it's due solely to the head
For exposure, roll and identify the bullet holes
Secondary survey should be limited to bullet trajectory based on x-rays, not comprehensive like in blunt trauma
Get to the OR as fast as possible because minutes matter in penetrating trauma
Most of what we do in pediatric trauma is non-operative now
If there's not a massive transfusion protocol at your trauma center, you need one
Simulations are very helpful for penetrating trauma preparedness
REBOA describes an endovascular procedure in which a blocking balloon is introduced into the aorta to reduce bleeding
There's some controversy about REBOA even in adult trauma centers, with some centers liking it and some not
REBOA balloons are not small enough for children at this time
Firearm injuries are now the leading killer of children in the United States