Firearm injuries are a leading cause of pediatric mortality in the United States. The frequency of pediatric extremity firearm injuries and the high repeat incidence in high-risk patients make it important for emergency clinicians to understand how to manage these injuries.
Our recent issue, Pediatric Firearm Injuries to the Extremity: Management in the Emergency Department, focuses on the acute management of firearm injuries to the extremities of pediatric patients, drawing from the pediatric literature or extrapolated from adult literature where pediatric evidence is scarce.
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Our August 2022 issue Pediatric Firearm Injuries to the Extremity: Management in the Emergency Department is free for everyone, so you can read the full issue here.
Here are a few key points:
- Exsanguinating pediatric firearm injuries to the extremity in which bleeding is not controlled with hemostatic gauze should prompt immediate application of a tourniquet.
- If possible, the tourniquet should be removed within 120 minutes. Contraindications to removal include distal traumatic amputation, hemodynamic instability, other life-threatening injuries, and inability to monitor the wound for signs of rebleeding. (See Table 5 in the issue.)
- If the tourniquet has been in place for >120 minutes, be prepared to monitor and manage complications such as rhabdomyolysis and/or compartment syndrome.
- Hard signs of extremity injury include pulsatile external bleeding, expanding hematoma, thrill, bruit, pulselessness, pallor, and/or neurologic deficit.
- If hard signs are absent, calculate an arterial pressure index (API) by comparing the systolic blood pressure obtained through Doppler evaluation of the injured extremity over the systolic blood pressure of the uninjured extremity.
- Obtain a computed tomography angiogram if the API is <0.9 or if there is any concern for a vascular injury.
Last Updated on January 25, 2023