Update Course Rewind: Preparing for Penetrating Trauma 2022

We are seeing a lot of penetrating trauma in the United States. And there are more and more firearm injuries, even in younger kids. Sadly, it's now the leading killer of children. And these children are coming to our pediatric trauma centers. So in this session, Dr. Bindi Makharia will help us to be better prepared for penetrating trauma. A lot of ATLS is focused on blunt trauma and there's not as much teaching actually for penetrating trauma. So one of the things we've done in our hospital is have simulations with the emergency room and have lectures about this on how you manage penetrating trauma differently from blunt trauma. So first of all, the main thing is that time is of the essence. You want to get these children to the operating room as quickly as possible. There's a much higher likelihood of rapid massive bleeding, of needing an OR, chest tube or ED thoracotomy, and that potential injuries are directly determined by bullet trajectory. Also, you want to get really quick x-rays. They are very helpful. So for example, on this kid, the bullet could have either gone down into the pelvis or run up into the chest, and that really determines what might have been injured. So just teaching the emergency room physicians and residents about this has been really helpful. This came up with the modified ATLS principles for penetrating trauma. So A is for airway. Unlike other blunt injuries, we try not to incubate until it's absolutely necessary. be saved for the OR in case they're hypotensive and also you don't want to waste time. B, bleeding. So if it's a chest gunshot wound, place the chest tube on the injured side. C, ate if there's an extremity injury, plus minus pressure, blood, activate the massive transfusion protocol. D, disability, doesn't matter unless it's due solely to the head. E, an exposure, roll and identify the bullet holes. And then for secondary survey, limited to bullet trajectory based on x-rays. We don't care about the tympanic membranes and all that other stuff that they normally look at with blunt trauma. And then disposition. Get to the OR as fast as possible because minutes matter. So it may be necessary for more and more children's hospitals to get used to this until this epidemic goes away, if it ever will. There's courses that you can take here in the states. one of them is acid, trauma surgical exposure techniques for people that may not have done trauma operations in a long time because most of what we do in pediatric trauma is non-operative now. Massive transfusion protocol, if there's not one at your trauma center, you need one. Simulations are very helpful, and of vascular options. If you don't have vascular surgeons on staff or people don't have the necessary equipment then that needs to be done. One of the endovascular options is Reboa. Reboa or resuscitative endovascular balloon occlusion of the aorta describes an endovascular procedure in which a blocking balloon is introduced into the aorta to reduce bleeding. So Reboa, I think that there's some controversy even in the adult trauma centers. Some centers like it and some don't and balloons are not small enough for children at this time, but it may be something that's coming down the line. And then plus minus some mass shooting drills. We actually did one of these once and it was really traumatizing to the children, so stopped doing them, but it did show us that we're really lacking in a lot of resources if it actually did happen, so. Thank you for watching this video. Don't forget to subscribe to our YouTube channel, follow us on social media and download the Stay Current app for hundreds of pieces of content in pediatric surgery. Cincinnati Children's Hospital and Stay Current are sharing knowledge to improve child health around the globe.