Pediatric emergency medicine trisk 3405 3405

typically occur in the context of falls while straddling climbing structures in playgrounds, sports equipment, or bicycles The injuries may range from minor lacerations and hematomas to penetrating extensive lacerations These types of injuries should also cue the emergency provider to consider sexual assault as a cause (see Chapter 127 Sexual Assault: Child and Adolescent ) In girls, vulvar hematomas or lacerations can occur as a result of a straddle injury It is essential to determine the extent of the injury before determining the best repair, if any If the injury is not fully visualized by the emergency provider secondary to pain or blood obscuring the visualization, consultation with a surgical specialist and/or examination under anesthesia are recommended Vulvar lacerations usually heal by secondary intention—topical antibiotics and sitz baths help the healing process For gaping, deeper lacerations which require primary closure, the placement of absorbable sutures under procedural sedation or general anesthesia is recommended If a penetrating injury has led to a vaginal laceration, a surgical consultation and consideration for examination under anesthesia are recommended In boys, straddle injuries may lead to penile or scrotal lacerations A thorough genitourinary examination is required to determine the extent of injury If injury to the urethra is suspected, surgical specialty consultation is warranted and a retrograde urethrogram is required Superficial lacerations to the penile shaft and scrotum can be repaired with absorbable sutures Local anesthesia with a penile block and/or procedural sedation may be required Urology consultation is recommended if the laceration involves the corporal body of the penile shaft or urethra Scrotal lacerations also result from sports-related injuries Superficial lacerations can be repaired with absorbable sutures but if the laceration extends to the dartos layer or is penetrating, there is a risk of testicular injury and this requires surgical specialty consultation in a timely manner VASCULAR INJURIES CLINICAL PEARLS AND PITFALLS Vascular injuries may present with a large hematoma, pulsating bleeding, absent or diminished distal pulses, and color changes A thoughtful approach with adequate preparation and appropriate consultation is required before exploring a potential vascular injury