J Trauma
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Although emergency department (ED) thoracotomy is performed only in selected adult trauma victims, it continues to be widely used in children. To evaluate if use of this liberal policy is justified in children, the charts of 23 pediatric trauma victims who underwent ED thoracotomy at our institution in the past 5 years were reviewed. Mechanism of injury was blunt trauma in 65% and penetrating injury in 35%. ⋯ This study demonstrates that children who arrive at the ED following blunt or penetrating trauma with no cardiac rhythm are unsalvageable and should not undergo ED thoracotomy. The burden of unreimbursed care for this procedure is not trivial. Indications for ED thoracotomy in pediatric trauma victims should therefore be the same as those currently used for adult trauma victims.
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We report the case of a 27-year-old patient with blunt thoracic trauma in whom transesophageal echocardiography enabled an early diagnosis of severe myocardial contusion. Conventional mechanical ventilation dramatically enhanced cardiogenic shock because of myocardial contusion, requiring increasing doses of catecholamine. High-frequency jet ventilation produced an immediate improvement in hemodynamic status, permitting a decrease in catecholamine administration.
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Computerized tomographic (CT) scanning for blunt abdominal trauma has focused on initial emergency department evaluation. At our institution, CT scanning is often used on a delayed basis for unexplained drops in hematocrit, investigation of bony injuries, or subtle abdominal findings. We reviewed 268 such scans. ⋯ There was no difference in the pre-scan hematocrit drop in patients with normal scans (6.6%), positive scans (6.8%), and those who were explored (6.4%). There was one false positive (0.4%) and two false negative scans (0.8%). Conclusions. (1) A significant number of occult injuries, some life threatening, are detected by delayed CT scans. (2) Hematocrit drop under observation is not a good predictor of occult intra-abdominal injury. (3) Delayed CT scanning for occult abdominal injury is cost effective.
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We computed regression coefficients for TRISS analysis for all 4271 pediatric patients (aged 1 through 14 years) with complete data from the Major Trauma Outcome Study. We then compared predicted pediatric and adult TRISS survival probability norms. ⋯ The study confirmed that the TRISS adult blunt norm is highly discriminating and reliable in predicting survival probabilities for pediatric patients. Given that both norms were equally good predictors, and the importance of a consistent system to evaluate trauma care, the authors recommend the continued use of the adult blunt trauma norm for estimating survival probability in children.
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We report the case of a 14-month-old child with hydrofluoric acid burns who suffered cardiac arrest in association with profound hypocalcemia and hyperfluoridemia. Successful treatment included topical, subeschar, and intravenous calcium gluconate administration.