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Pediatric emergency medicine trisk 3697 3697

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in adults Hemothorax secondary to an injury of the great vessels usually results in death at the scene Hemothorax from injury to smaller vessels and pneumothorax have low mortality rates Goals of Treatment Immediate recognition and stabilization of airway, breathing, and circulation is crucial to management of pneumothoraces and hemothoraces Opening and then securing the airway with endotracheal intubation is the first step for a child with severe respiratory distress, inadequate oxygenation or ventilation, or depressed mental status after trauma Breathing may be supported via mechanical ventilation and evacuation of intrapleural air and blood Circulation may become impaired during tension physiology via obstruction of venous return, and evacuation of the pleura via needle or tube thoracostomy is immediately necessary Circulation may also be affected by blood loss into the thorax necessitating volume replacement with appropriate IVF and possible blood transfusion For the stable patient with pneumo- or hemothorax, the focus is on careful evaluation and treatment to prevent deterioration Chest radiograph (CXR) and ultrasound (US) may be helpful to identify the extent of the injury and the need for intervention Depending on the clinical progression, treatment may involve observation, tube thoracostomy, or surgical intervention Clinical Considerations Clinical Recognition Pneumothorax or hemothorax should be suspected in any child with a history of thoracic trauma who presents with chest pain, shortness of breath, respiratory distress, hypoxia, or evidence of shock Physical examination alone may be sufficient to make the diagnosis in patients with a large hemothorax or pneumothorax or severe complications such as tension physiology, but smaller lesions may be missed by examination alone All patients with a mechanism for a thoracic injury should undergo prompt radiologic evaluation with CXR, as an initial normal physical examination may be misleading Where available, bedside US can be used to augment the initial physical examination as it may facilitate identification of even small amounts of air or blood in the pleural space Triage Considerations Children with traumatic pneumothorax or hemothorax require immediate evaluation utilizing Advanced Trauma Life Support (ATLS) protocols and activation of the appropriate local trauma response In planning for a trauma

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