Ocular Chemical Injury Spector J, Fernandez WG Chemical, thermal, and biological ocular exposures Emerg Med Clin North Am 2008;26(1):125–136 Vajpayee RB, Shekhar H, Sharma N, et al Demographic and clinical profile of ocular chemical injuries in the pediatric age group Ophthalmology 2014;121(1):377–380 CHAPTER 124 ■ THORACIC EMERGENCIES JOY L COLLINS, MERCEDES M BLACKSTONE INTRODUCTION Thoracic emergencies in children often result in life-threatening alterations in cardiorespiratory physiology A rapid, yet organized, approach to the child with a thoracic emergency is essential The purpose of this chapter is to describe nontraumatic surgical diseases of the thorax and guide the evaluating healthcare provider in the diagnosis and treatment of these conditions Congenital abnormalities that are usually diagnosed at birth are not included Thoracic trauma is discussed in Chapter 115 This chapter reviews the pathophysiology and clinical manifestations of thoracic emergencies, as well as the general principles of physical and laboratory assessment Subsequent sections cover specific entities within the following categories: (i) airway obstruction, (ii) violations of the pleural space, (iii) intrinsic pulmonary lesions, (iv) mediastinal tumors, (v) diaphragmatic defects, and (vi) chest wall tumors GOALS OF EMERGENCY THERAPY Children with thoracic emergencies present with a spectrum of processes and severities Because of the potential for thoracic emergencies to be serious and even life threatening, a rapid but organized approach to the assessment and treatment of these patients is crucial Providers should rapidly address respiratory and hemodynamic compromise, and identify those entities that require prompt surgical consultation in the ED KEY POINTS Respiratory function requires flow of air along a pressure gradient into the tracheobronchial tree Any compressive or obstructive force can compromise this process, resulting in a thoracic emergency The emergency clinician evaluating the child with a thoracic problem must attempt to determine whether the patient has evidence of airway compromise, circulatory compromise, or components of both Thoracic conditions of surgical significance frequently present as a result of a mechanical or infectious complication of an underlying anatomic abnormality These anatomic abnormalities may be grouped into conditions resulting in airway compromise, violations of the pleural space, intrinsic lesions of the lung, mediastinal masses, and diaphragmatic defects Exceptions include pneumothorax and empyema, which can present in previously healthy children and which require prompt detection and treatment RELATED CHAPTERS Signs and Symptoms: Foreign Body: Ingestion and Aspiration: Chapter 32 Pain: Back: Chapter 54 Pain: Dysphagia: Chapter 56 Respiratory Distress: Chapter 71 Stridor: Chapter 75 Wheezing: Chapter 84 Medical, Surgical, and Trauma Emergencies Infectious Disease Emergencies: Chapter 94 Pulmonary Emergencies: Chapter 99 Thoracic Trauma: Chapter 115 Procedures: Chapter 130 Ultrasound: Chapter 131 The Children’s Hospital of Philadelphia Clinical Pathway Clinical Pathway for Evaluation and Treatment of Child With Community-Acquired Pneumonia URL: https://www.chop.edu/clinical-pathway/pneumonia-communityacquired-clinical-pathway Authors: J Gerber, MD, PhD; T Metjian, PharmD; M Siddharth, MD; D Davis, MD, MSCE; T Florin, MD; J Zorc, MD; T Kaur, MD; T Blinman, MD; D Mong, MD; X Bateman, CRNP; E Pete Devon, MD; Ron Keren, MD, MPH; L Bell, MD; L Utidjian, MD; E Moxey, RN, MPH Posted: September 2012, revised December 2019 CLINICAL MANIFESTATIONS Physical Examination Evaluation of the child with a thoracic emergency requires a calm, orderly assessment of airway, breathing, and circulation (ABCs) In assessing the airway, the physician must evaluate the adequacy of air movement and gas exchange Pulse oximetry should be performed upon the patient’s arrival Anxiety or confusion in a patient with a thoracic emergency may be evidence of hypoxemia Increased work of breathing may indicate partial airway obstruction and can be evaluated by assessing the use of intercostal, subcostal, and supraclavicular accessory muscles Prolonged use of these accessory muscles may result in fatigue and the most common cause of cardiac arrest in children—respiratory arrest Breathing is best evaluated by palpation and auscultation of the chest The trachea should be palpated to ensure it is midline Any lateralization of the trachea is suggestive of either unilateral volume loss or a lateral space-occupying process, such as a pneumothorax, pleural effusion, or mass The neck and chest should be palpated for signs of subcutaneous emphysema, suggestive of a pneumothorax or airway injury with an air leak Finally, breath sounds should be assessed via auscultation for symmetry and adequacy of inspiratory and expiratory airflow Evaluation of the cardiovascular system should include an assessment of the patient’s pulse for quality, rate, and regularity The peripheral skin should be assessed for color, temperature, and capillary refill Signs of poor perfusion often precede that of pressure instability The neck should be assessed for signs of jugular venous distension Finally, the heart should be examined for signs of ... Any compressive or obstructive force can compromise this process, resulting in a thoracic emergency The emergency clinician evaluating the child with a thoracic problem must attempt to determine... lesions, (iv) mediastinal tumors, (v) diaphragmatic defects, and (vi) chest wall tumors GOALS OF EMERGENCY THERAPY Children with thoracic emergencies present with a spectrum of processes and severities... alterations in cardiorespiratory physiology A rapid, yet organized, approach to the child with a thoracic emergency is essential The purpose of this chapter is to describe nontraumatic surgical diseases