RESUMEN
Tracheal injury from blunt trauma is a rare, life-threatening condition in pediatric patients. Rapid assessment and identification of the severity of the injury will increase the likelihood of survival. Subcutaneous emphysema, pneumomediastinum, and persistent pneumothoraces after chest tube placement should be considered in the index of suspicion for tracheal injury. Treatment for a complete tracheal transection includes rapid airway securement via endotracheal tube or tracheostomy and careful surgical repair in the operating room in conjunction with bronchoscopy.
Asunto(s)
Grupo de Atención al Paciente/organización & administración , Traumatismos Torácicos/terapia , Tráquea/lesiones , Tráquea/cirugía , Heridas no Penetrantes/terapia , Accidentes de Tránsito , Broncoscopía/métodos , Niño , Terapia Combinada , Urgencias Médicas , Femenino , Estudios de Seguimiento , Humanos , Puntaje de Gravedad del Traumatismo , Intubación Intratraqueal , Medición de Riesgo , Traumatismos Torácicos/diagnóstico , Toracotomía/métodos , Traqueostomía , Resultado del Tratamiento , Heridas no Penetrantes/diagnósticoRESUMEN
Grounded in research on posttraumatic stress etiology, "trauma-informed pediatric care" integrates understanding of posttraumatic stress, and specific practices to reduce posttraumatic stress, into clinical care of ill or injured children. Across five level I or II pediatric trauma centers, 232 nurses completed a survey of knowledge, opinions, self-rated competence, and current practice with regard to trauma-informed nursing care. Participants were knowledgeable and generally held favorable opinions about trauma-informed care. The majority considered themselves moderately competent in a range of relevant skills; their recent practice showed most variability with regard to teaching patients and parents how to cope with upsetting experiences.
Asunto(s)
Actitud del Personal de Salud , Competencia Clínica , Enfermería Pediátrica/métodos , Trastornos por Estrés Postraumático/enfermería , Heridas y Lesiones/enfermería , Distribución de Chi-Cuadrado , Femenino , Encuestas de Atención de la Salud , Humanos , Modelos Logísticos , Masculino , Rol de la Enfermera , Relaciones Enfermero-Paciente , Psicología , Autoinforme , Encuestas y Cuestionarios , Centros Traumatológicos , Índices de Gravedad del Trauma , Heridas y Lesiones/diagnósticoRESUMEN
BACKGROUND: Management of splenic injury has shifted from operative to nonoperative management in both children and adults with reports of high success rates. Benefits of splenic conservation include decreased hospital stay, blood transfusion, and mortality, as well as avoidance of infectious complications. Angiography with embolization is an innovative adjunct to nonoperative management and has resulted in increased splenic salvage in adults; however, data in the pediatric population are scant. METHODS: A retrospective comparative study of a single-hospital trauma registry reviewed from 1999 to 2009. Patients 18 years and younger admitted with injury to the spleen were included. Children with penetrating injury were excluded. Children were divided into three categories by initial treatment: observation, embolization, or splenectomy. Data recorded include age, radiographic grade of injury, and Injury Severity Score (ISS). Groups were analyzed for success of initial treatment, requirement for transfusion of packed red blood cells, splenic salvage, and mortality. RESULTS: Registry review identified 259 children with blunt splenic injury. Initial treatment was observation in 227, embolization in 15, and splenectomy in 17. In the observation group, 9 (4%) of 227 children failed initial treatment; 8 of these underwent embolization, while 1 unerwent splenectomy. In the embolization group, 1 (7%) of 15 failed initial treatment and underwent splenectomy. Blood transfusion was required by 38 (17%) of 227 in the observation group, 6 (40%) of 15 (p = 0.02) in the embolization group, and 15 (88%) of 17 (p < 0.01) in the splenectomy group. Overall splenic salvage rate was 237 (92%) of 259. Three children died in the observation group, and four children died in the splenectomy group. There was no death in the embolization group. CONCLUSION: Splenic artery embolization for blunt trauma in children is associated with a higher blood transfusion rate compared with observation but offers a safe, intermediate alternative to splenectomy when observation fails. LEVEL OF EVIDENCE: Therapeutic study, level IV.
Asunto(s)
Embolización Terapéutica , Bazo/lesiones , Heridas no Penetrantes/terapia , Adolescente , Transfusión Sanguínea/estadística & datos numéricos , Niño , Preescolar , Femenino , Humanos , Lactante , Tiempo de Internación , Masculino , Radiografía , Estudios Retrospectivos , Bazo/irrigación sanguínea , Esplenectomía , Arteria Esplénica/diagnóstico por imagen , Arteria Esplénica/lesiones , Resultado del Tratamiento , Heridas no Penetrantes/cirugíaRESUMEN
Penetrating neck injuries are uncommon in children, and when they do occur, they can be a challenge to manage. Injuries can be cardiovascular, aerodigestive, and neurovascular. In the past, injuries were explored surgically to evaluate the extent of the injury; studies are now showing that observation and less invasive studies have a positive outcome for the patient. Immediate surgical intervention remains mandatory for the clinically unstable patient, whereas stable patients have studies done that pertain to their signs and symptoms, thus having a conservative nonoperative approach to care.