Penetrating Trauma
Inevitably, we are going to miss things, as it isn’t our job to diagnose every injury - Elliott Chinn DO
HWN Suggests
Penetrating Trauma: What We Miss and How We Can Improve
In the acute setting the most important thing we can miss is a tension pneumothorax. Thankfully, ultrasound is accessible and with ultrasound education being integral in most residency training programs, it is only a matter of time until most ED doctors can rule it out nearly 100% of the time.
In the patient with a history of penetrating trauma we need to be aware of two injures that could have been missed: diaphragmatic tears and ureteral injuries. While CT scans can miss asymptomatic tears, they are quite good at diagnosing organs that have herniated through the diaphragm so if you are suspicious of it, order that CT scan..
Finally, despite advances in imaging, hollow…
Featured
Abdominal and Thoracic Stab Wounds: ED Evaluation and Management
Each region carries higher risk for particular injuries. The posterior abdomen and flank are more associated with retroperitoneal and solid organ injuries, while the thoracoabdominal region is higher risk for injuries to the diaphragm and the anterior abdomen is highest risk for hollow viscus injury.
Articles of Interest
Pearls for the management of GSW associated traumatic injury
As with all critical patients, the first step is airway management. Care should be taken and best practices should be followed to allow for first pass success including preoxygenation if possible to avoid desaturation. Resuscitation before intubation if possible is important. The appropriate induction agent is of vital importance. Ketamine is associated with the most neutral hemodynamic properties, and it is also the ideal agent for head injured patients. By maintaining hemodynamic stability and its dissociative properties, it is useful to blunt the response to laryngoscopy. Fentanyl is another option as well at doses 3-5 mcg/kg IV.
Penetrating Wounds in the Emergency Department: Considerations for Management
Emergency physicians encounter penetrating trauma on a regular basis. Beyond Advanced Trauma Life Support protocols, the assessment of a patient presenting with a penetrating wound requires careful thought and thorough examination. If it’s been a while since you’ve reviewed the basics, let’s take a minute to work through a few cases and discuss the pearls and pitfalls for the management of penetrating injuries.
