TRAUMA - PAEDIATRIC
PENETRATING CHEST TRAUMA - PAEDS
Prompt4M - Knitting needle vs chest 
ResponsePenetrating injury with ?knitting needle to right lower anterior chest (?9th-11th interspace), line of nipple – knitting needle in situ, appears to be at right angle to chest wall, with foreign material at entry point
Unable to assess depth
Child appears comfortable, not distressed, co-operative and well perfused
Chest appears equally expanded right vs left
(IV access in right cubital fossa)
Unable to assess depth
Child appears comfortable, not distressed, co-operative and well perfused
Chest appears equally expanded right vs left
(IV access in right cubital fossa)
PromptComplications of above
ResponseTension pneumothorax
Simple pneumothorax
Haemothorax
Hepatic injury
Diaphragm injury
Vascular injury – less likely given location – intercostal
Intra-abdominal visceral injury – gastric, bowel
Infection – empyema
Cardiac injury +/- tamponade - unlikely
Simple pneumothorax
Haemothorax
Hepatic injury
Diaphragm injury
Vascular injury – less likely given location – intercostal
Intra-abdominal visceral injury – gastric, bowel
Infection – empyema
Cardiac injury +/- tamponade - unlikely
PromptManagement priorities of above
ResponseDecompress right chest – presumed tension pneumothorax
Resuscitation – fluid bolus, supplemental oxygen
Analgesia
Leave needle in situ
Urgent surgical review – removal of needle in OT
Resuscitation – fluid bolus, supplemental oxygen
Analgesia
Leave needle in situ
Urgent surgical review – removal of needle in OT