In this episode, Sam Ashoo, MD interviews Rawad Rayes, MD and Eva Tovar Hirashima, MD, MPH – two of the authors of the August 2022 PEMP article on Pediatric Firearm Injuries to the Extremity: Management in the Emergency Department.
Episode Outline:
How common are pediatric firearm injuries?
What is the most common location of these injuries?
Is there much literature published on this topic?
Epidemiology
- What’s been the trend in pediatric firearm injuries over the past 10 years?
- Do we have any idea how/why these are occurring (ie, accidental, intentional, etc)
Terminology: For those unfamiliar with firearms (table 1)
Ballistics: Mechanisms of damage.
Pre-hospital care
- Trauma center transport
- Prehospital hemorrhage control -- Combat application tourniquet, anything else?
ED Evaluation
- SIPA -- What is it and why use it?
- Primary survey -- Tachycardia -> delayed cap refill -> hypotension in children?
- Secondary Survey
- Diagnostic Studies:
- Damage Control Resuscitation
- Wound Care -- Do we remove projectiles? Can they stay in?
- Antibiotics
- Joint Involvement
- Compartment Syndrome -- 3 As vs 6 Ps
- Rhabdomyolysis
Controversies
- CTA for all injuries?
- Hemostatic devices -- Any role for these in the ED?