Pediatric emergency medicine trisk 3185 3185

TABLE 103.1 INDICATIONS FOR ABDOMINAL COMPUTED TOMOGRAPHIC SCAN IN PEDIATRIC TRAUMA PATIENTS Mechanism of injury suggesting abdominal trauma Significant abdominal tenderness (the most predictive sign for intraabdominal injury) Handlebar or seat belt ecchymosis Slowly declining hematocrit Unaccountable fluid or blood requirements Neurologic injury precluding accurate abdominal examination Hematuria Acute “need to know” (e.g., before general anesthesia) FOCUSED ABDOMINAL SONOGRAPHY FOR TRAUMA Goals of Treatment FAST is typically performed in the ED during the secondary survey The operator looks at four windows in the abdomen: the left upper quadrant, the right upper quadrant, the pericardium via a subxiphoid window, and the pelvis The purpose of the scan is to detect free fluid Free fluid in any of these areas indicates the need for further evaluation and treatment The utility of FAST in the management of pediatric patients remains controversial The literature for pediatric patients with intra-abdominal injuries suggests that FAST is not sufficiently sensitive and CT scanning remains the gold standard for the radiologic evaluation in children Since the mere presence of free fluid within the abdomen is not an indication for operative intervention in hemodynamically stable children, a positive FAST merits additional imaging On the other hand, a negative FAST does not exclude significant intra-abdominal injury Nonetheless, there is a role for FAST in pediatric populations, particularly in unstable children or children who need immediate transfer to the operating suite for an emergent procedure, such as cranial decompression Although a negative FAST finding does not exclude injury, a positive FAST finding is evident enough to warrant exploration of the abdomen, either with laparoscopy or with laparotomy, in such a patient (see Chapter 131 Ultrasound ) CLINICAL PEARLS AND PITFALLS