Pediatric Firearm Injuries to the Extremity

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? 

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