Rural Medicine: Pediatric Trauma

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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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Richard A. -

This was harrowing but also hugely beneficial to listen to - thank you for sharing.

I had a slightly related question maybe somebody could provide some input in to. In this case probably not practical given the plethora of on-going resuscitation needed, but is there any role for the use of measurement of optic-nerve sheath diameter (ONSD) in the pediatric population to detect raised ICP where CT/MRI is not available or not practical?

In BC, Canada, our critical care paramedics will use this in the adult population (https://handbook.bcehs.ca/treatment-guidelines/critical-care-guidelines/traumatic-brain-injury/) but I'm not sure on the applicability to the pediatric population? I did find this narrative review (https://www.sciencedirect.com/science/article/pii/S2319417020300329) but I am unsure on the practical application of the findings.

Thank you again.

Chuck S., M.D. -

Great job and great discussion of your thought processes and really appreciated.
I would suggest that you didn't miss the abdominal trauma but that it was more likely a result of the chest compressions given the negative FAST X2. Those types of injures are well described (at least in adults and children seem at greater risk) in chest compressions both mechanical and manual.

Julie V. -

Chuck, thanks for your comments. I will have to read more about that!
-Julie

Chuck S., M.D. -

Here is the reference for effects of CPR (reviewed on EMA) Use Of Whole Body CT To Detect Patterns Of CPR-Related Injuries
After Sudden Cardiac Arrest
Dunham, G.M., et al, Eur Radiol 28(10):4122, October 2018

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