Pediatric Firearm Injuries to the Extremity

EMplify by EB Medicine

In this episode, Sam Ashoo, MD interviews Rawad Rayes, MD and Eva Tovar Hirashima, MD, MPH – two of the authors of the August 2022 PEMP article on Pediatric Firearm Injuries to the Extremity: Management in the Emergency Department.

Episode Outline:

How common are pediatric firearm injuries?

What is the most common location of these injuries?

Is there much literature published on this topic?

Epidemiology

• What’s been the trend in pediatric firearm injuries over the past 10 years?
• Do we have any idea how/why these are occurring (ie, accidental, intentional, etc)

Terminology: For those unfamiliar with firearms (table 1)

Ballistics: Mechanisms of damage.

Pre-hospital care

• Trauma center transport
• Prehospital hemorrhage control -- Combat application tourniquet, anything else?

ED Evaluation

• SIPA -- What is it and why use it?
• Primary survey -- Tachycardia -> delayed cap refill -> hypotension in children?
• Secondary Survey
• Diagnostic Studies:
• Damage Control Resuscitation
• Wound Care -- Do we remove projectiles? Can they stay in?
• Antibiotics
• Joint Involvement
• Compartment Syndrome -- 3 As vs 6 Ps
• Rhabdomyolysis

Controversies

• CTA for all injuries?
• Hemostatic devices -- Any role for these in the ED?