Pediatric Firearm Injuries to the Extremity: Management in the Emergency Department (Trauma CME and Pharmacology CME)

Pediatric Firearm Injuries to the Extremity: Management in the Emergency Department (Trauma CME and Pharmacology CME) is organized by EB Medicine.

Date of Original Release: August 1, 2022
Termination Date: August 01, 2025

Description:
Because of the frequency of pediatric extremity firearm injuries and the high repeat incidence in high-risk patients, it is important for emergency clinicians to understand how to manage these injuries. This issue reviews evidence-based recommendations for the initial assessment and acute management of firearm injuries to the extremities of pediatric patients. Pertinent ballistic principles, novel management, current trends, and controversies are also discussed. In this issue, you will learn:

• Ballistic principles that can affect the degree of tissue damage
• Terminology for types of firearms, ammunition, and firearm setting and modifications
• Recommendations for prehospital hemorrhage control
• Indications for tourniquet applications, contraindications for tourniquet removal, and recommendations for monitoring after tourniquet release in the ED
• Steps for the correct application of a tourniquet
• Key aspects of the primary and secondary survey, with special considerations for pediatric patients
• Recommendations for extremity examination, including when and how to calculate an arterial pressure index
• Which diagnostic studies are recommended and when they are indicated
• Recommendations for damage control resuscitation and hemostatic resuscitation, management of vascular injuries, bone and local wound care, and management of injuries with joint involvement
• Which antibiotic regimens are recommended for different types of wounds
• Acute complications and secondary injuries including compartment syndrome, rhabdomyolysis, and secondary ischemic injuries
• How emergency clinicians can play a role in reducing recurrence of firearm injuries

Needs Assessment: The need for this educational activity was determined by a practice gap analysis; a survey of medical staff, including the editorial board of this publication; review of morbidity and mortality data from the CDC, AHA, NCHS, and ACEP; and evaluation responses from prior educational activities for emergency physicians.

Goals: Upon completion of this activity, you should be able to: (1) identify areas in practice that require modification to be consistent with current evidence in order to improve competence and performance; (2) develop strategies to accurately diagnose and treat both common and critical ED presentations; and (3) demonstrate informed medical decision-making based on the strongest clinical evidence.

CME Objectives: Upon completion of this activity, you should be able to: (1) discuss the indications for tourniquet placement and contraindications for tourniquet removal in the management of pediatric firearm injuries to the extremity; (2) describe indications for immediate operative management; (3) calculate and interpret an arterial pressure index; and (4) describe interventions that can be used at the bedside to reduce the risk for firearm injury recurrence.