Pediatric emergency medicine trisk 907
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (196.82 KB, 4 trang )
of sympathetic input to the vascular system. The physical examination may be
misleading in that these patients are bradycardic (unable to mount tachycardic
response to relative hypovolemia) and demonstrate warm, flushed skin in the
setting of hypotension (loss of vasomotor tone). These symptoms may also be
superimposed on traumatic (hypovolemic) shock. These patients need fluid
resuscitation and may require inotropic (alpha agonist) support, such as
norepinephrine or phenylephrine, to maintain adequate perfusion and avoid fluid
overload. Appropriate fluid management is important in preventing hypoperfusion
of the already injured spinal cord. The use of steroids for blunt cervical injury is
not routinely recommended. Several authors suggest that steroid administration
increases potential risk to the patient and does not lead to meaningful neurologic
recovery and that its use as a standard of care is not justified. Steroid use for the
pediatric patient with a clear or potential blunt cervical cord injury is not well
supported by available evidence and should be discussed in consultation with the
treating orthopedic and neurosurgical physicians bearing in mind that it is not
approved by the Federal Drug Administration for this purpose.
Methylprednisolone is not recommended in conjunction with penetrating neck
injuries.
FIGURE 112.36 Normal ossiculum terminale at the tip of the dens (arrow ). (Reprinted with
permission from Swischuk L. Emergency Radiology of the Acutely Ill or Injured Child . 2nd ed.
Baltimore, MD: Williams & Wilkins; 1986:717.)
FIGURE 112.37 Magnetic resonance imaging (MRI) of cervical spine demonstrating epidural
hematoma (arrow ) from C5 to T1. Note excellent soft tissue, intervertebral disc, and fluid detail
afforded by the MRI scan.
Suggested Readings and Key References
Blunt and Penetrating Neck Trauma
Abujamra L, Joseph MM. Penetrating neck injuries in children: a retrospective
review. Pediatr Emerg Care 2003;19:308–313.
Bell RB, Osborn T, Dierks EJ, et al. Management of penetrating neck injuries: a
new paradigm for civilian trauma. J Oral Maxillofac Surg 2007;65:691–705.
Chatterjee D, Agarwal R, Bajaj L, et al. Airway management in laryngotracheal
injuries from blunt neck trauma in children. Paediatr Anaesth 2016;26(2):132–
138.
Cheng J, Cooper M, Tracy E. Clinical consideration for blunt laryngotracheal
trauma in children. J Pediatr Surg 2017;52(5):874–880.
Dandu K, Carniol E, Sanghvi S, et al. A 10-year analysis of head and neck injuries
involving nonpowder firearms. Otolaryngol Head Neck Surg 2017;156(5):853–
856.
Desai N, Kang J, Chokshi F. Screening CT angiography for pediatric blunt
cerebrovascular injury with emphasis on the cervical “seatbelt sign.” AJNR Am
J Neuroradiol 2014;35(9):1836–1840.
Feldman KW, Avellino AM, Sugar NF, et al. Cervical spinal cord injury in abused
children. Pediatr Emerg Care 2008;24:222–227.
Gee AC, Salter KD, McConnell DB, et al. Injuries to the neck. In: Flint L,
Meredith J, Schwab CW, et al., eds. Trauma Contemporary Principles and
Therapy. Philadelphia, PA: Lippincott Williams & Wilkins; 2008:335–349.
Gonzalez RP, Falimirski M, Holevar MR, et al. Penetrating zone II injury: does
dynamic computed tomography scan contribute to the diagnostic sensitivity of
physical examination for surgically significant injury? A prospective blinded
study. J Trauma 2003;54:61–64; discussion 64–65.
Graham J, Dick R, Parnell D, et al. Clothesline injury mechanism associated with
all-terrain vehicle use by children. Pediatr Emerg Care 2006;22:45–47.
Hanson CA, Smith JA. Penetrating neck injuries in children. J Trauma Nurs
2007;14:12–16; quiz 17–18.
Inaba K, Munera F, McKenney M, et al. Prospective evaluation of screening
multislice helical computed tomographic angiography in the initial evaluation
of penetrating neck injuries. J Trauma 2006;61:144–149.
Insull P, Adams D, Segar A, et al. Is exploration mandatory in penetrating zone II
neck injuries? ANZ J Surg 2007;77:261–264.
Klinkner DB, Arca MJ, Lewis BD, et al. Pediatric vascular injuries: patterns of
injury, morbidity, and mortality. J Pediatr Surg 2007;42:178–182; discussion
182–183.
Losek JD, Tecklenburg FW, White DR. Blunt laryngeal trauma in children: case
report and review of initial airway management. Pediatr Emerg Care
2008;24:370–373.
Low GM, Inaba K, Chouliaras K, et al. The use of the anatomic ‘zones’ of the
neck in the assessment of penetrating neck injury. Am Surg 2014;80(10):970–
974.
Madsen A, Oosthuizen G, Laing G, et al. The role of computed tomography
angiography in the detection of aerodigestive tract injury following penetrating
neck injury. J Surg Res 2016;205(2):490–498.
Marathe US, Tran LP. Pediatric neck trauma causing massive subcutaneous
emphysema. J Trauma 2006;61:440–443.
Markus-Rodden MM, Bojko T, Hauck LC. Traumatic tracheal laceration in a
pediatric patient medically managed with high-frequency oscillatory
ventilation. Pediatr Emerg Care 2008;24:236–237.
Marom T, Russo E, Ben-Yehuda Y, et al. Oropharyngeal injuries in children.
Pediatr Emerg Care 2007;23:914–918.
Mezhir JJ, Glynn L, Liu DC, et al. Handlebar injuries in children: should we raise
the bar of suspicion? Am Surg 2007;73:807–810.
Navsaria P, Thoma M, Nicol A. Foley catheter balloon tamponade for lifethreatening hemorrhage in penetrating neck trauma. World J Surg
2006;30:1265–1268.
Oliver J, Avraham J, Frangos S, et al. The epidemiology of inpatient pediatric
trauma in United States hospitals 2000 to 2011. J Pediatr Surg 2018;53(4):758–
764.
Stone M, Farber B, Olorunfemi O, et al. Penetrating neck trauma in children: an
uncommon entity described using the National Trauma Data Bank. J Trauma
Acute Care Surg 2016;80(4):604–609.
Tallon JM, Ahmed JM, Sealy B. Airway management in penetrating neck trauma
at a Canadian tertiary trauma centre. J Can Assoc Emerg Phys 2007;9:101–104.
Tessler R, Nguyen H, Newton C, et al. Pediatric penetrating neck trauma: hard
signs of injury and selective neck exploration. J Trauma Acute Care Surg
2017;82(6):989–994.
Verschueren DS, Bell RB, Bagheri SC, et al. Management of laryngo-tracheal
injuries associated with craniomaxillofacial trauma. J Oral Maxillofac Surg
2006;64:203–214.
Vohra S, Johnston BC, Cramer K, et al. Adverse events associated with pediatric
spinal manipulation: a systematic review. Pediatrics 2007;119:e275–e283.
