This issue includes 4 hours of ACEP/AMA category 1 CME credit.
Authors: Antonio Muñiz, MD, FACEP, FAAP, FAAEM Peer Reviewers: Adam Vella, MD and Paula Whiteman MD, FACEP, FAAP
Publication Date: March 1, 2008
Excerpt from the issue… A four-year-old female, who was a lap belt restrained, back-seat-passenger involved in a motor vehicle collision, presents with head pain and right thigh pain. The car she was in hit the guardrail with a frontal impact at 70 mph. The child lost consciousness momentarily. Initial vital signs included a blood pressure of 100/62 mmHg, a heart rate of 136/minute, and a respiratory rate of 36/minute. The only abnormalities on examination included a left parietal contusion and deformity to her right femur. A large-bore intravenous catheter was initiated and 20 mL/kg of 0.9% normal saline solution was administered as she was transported to your emergency department. Your abdominal evaluation revealed a seat-belt contusion with a soft and nontender abdomen. What are the priorities in the initial evaluation and management of this child? How do you evaluate the potential intra-abdominal injuries?
About this article: Trauma is the leading cause of morbidity and mortality in children. Trauma stats include nearly 1.5 million injuries, 500,000 hospitalizations, 20,000 deaths, and over 120,000 permanently disabled victims annually. Blunt trauma accounts for approximately 90% of all pediatric injuries, with falls and motor vehicle collisions representing the most common mechanisms of injury. Head and extremity injuries occur most frequently however, injury to the abdomen can occur in up to 8% of children, and abdominal injury is responsible for 9% of all trauma deaths. Significant abdominal trauma occurs in 25% of children sustaining multisystem injuries. While head and thoracic injuries are the most common cause of trauma-related death, abdominal trauma is the leading cause of initially unrecognized fatal injury in children.
This issue of Pediatric Emergency Medicine Practice will present a systematic approach to the presentation, evaluation, and initial management of pediatric patients with blunt abdominal trauma.
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