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?
Last Updated on January 25, 2023
Sam Ashoo, MD, FACEP, is board certified in emergency medicine and clinical informatics. He serves as EB Medicine’s editor-in-chief of interactive clinical pathways and FOAMEd blog, and host of EB Medicine’s EMplify podcast. Follow him below for more…
