Pediatric emergency medicine trisk 3569 3569
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (69.45 KB, 1 trang )
Contrast esophagram is helpful in evaluating the esophagus for tears or
perforations, but false-negative rates of up to 50% have been reported. Evaluation
can also include indirect mirror laryngoscopy to assess the larynx, vocal cord
mobility, presence of mucosal edema, ecchymosis, and mucosal tears, as well as
direct endoscopy to examine for tracheal, bronchial, and esophageal damage.
Flexible endoscopy may be less invasive and easier to accomplish, but rigid
endoscopy offers the most complete examination. Even rigid endoscopy, however,
is not 100% sensitive in detecting tracheal and esophageal injuries. As mentioned,
operative evaluation is mandatory for some patients and optional for others.
Determinants of specific management direction include mechanism of injury,
wound size and type, patient signs and symptoms, and relative stability.
Clinical Indications for Discharge or Admission
Patients can be discharged if they do not have a significant injury without
platysmal penetration, are hemodynamically stable, without airway compromise,
able to tolerate oral intake, and no indication or risk of abusive trauma or neglect
is present. Otherwise, admission is indicated.
BLUNT TRAUMA
Goals of Treatment
To ensure airway patency, respiratory sufficiency, hemorrhage control, cervical
spine stability, and identify and prevent progression of injuries to all structures
and tissues within the neck, including the airway, major blood vessels, neurologic,
and osseous structures.
CLINICAL PEARLS AND PITFALLS
