Evaluation and Management of Pediatric Patients With Penetrating Trauma to the Torso (Trauma CME)

Evaluation and Management of Pediatric Patients With Penetrating Trauma to the Torso (Trauma CME) is organized by EB Medicine

Date of Original Release: May 1, 2019
Date of most recent review: April 15, 2019.
Termination date: May 1, 2022.
CME Expiration Date: June 1, 2022

Target Audience:
 This enduring material is designed for emergency medicine physicians, physician assistants, nurse practitioners, and residents.

CME Credits:
4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. 

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 2 Pharmacology CME credits

About this Issue:
Children with penetrating trauma to the torso require careful evaluation of the chest, abdomen, pelvis, and genital structures for system-specific injuries that may contribute to rapid decompensation and influence the order of emergent resuscitation. This issue provides an evidence-based approach to the assessment and management of pediatric patients who present with penetrating injuries to the torso. You will learn:

• Principles of firearm ballistics and how the type of weapon relates to the gunshot wound it creates
• Physiologic and anatomic criteria that indicate a patient will have better survival outcomes if transported via helicopter versus ground transport
• Key aspects to consider while performing the primary survey and secondary survey
• Which methods for estimating a child’s weight are most accurate
• A quick method for estimating the appropriate chest tube size
• How tools such as the Injury Severity Score and Pediatric Trauma Score can be used to estimate the severity of injuries and associated morbidity/mortality
• Evidence-based recommendations for management of pediatric patients with penetrating trauma, based on the location of the injuries, including:
• When a patient with thoracic penetrating trauma should be sent emergently to the operating room
• Which laboratory studies are recommended, and which have little clinical utility
• Which imaging studies should be performed, and which are less sensitive/specific in patients with penetrating trauma
• The benefits of laparoscopy, and when laparoscopy should be converted to laparotomy

Goals: 
Upon completion of this activity, you should be able to: 
• demonstrate medical decision-making based on the strongest clinical evidence; 
• cost-effectively diagnose and treat the most critical presentations; and 
• describe the most common medicolegal pitfalls for each topic covered.

CME Objectives:
Upon completion of this article, you should be able to:
• Recognize signs and symptoms corresponding to underlying injuries associated with penetrating trauma
• Perform initial stabilizing procedures used for penetrating injuries of the chest, abdomen, and pelvis
• Choose appropriate, evidence-based diagnostic studies to identify clinically important injuries sustained from penetrating trauma
• Appropriately disposition pediatric patients with penetrating injuries.