Pediatric Firearm Injuries to the Extremity

In this episode, Sam Ashoo, MD interviews Rawad Rayes, MD and Eva Tovar Hirashima, MD, MPH – two of the authors of the August 2022 PEMP article on Pediatric Firearm Injuries to the Extremity: Management in the Emergency Department.

Episode Outline:

How common are pediatric firearm injuries? 

What is the most common location of these injuries? 

Is there much literature published on this topic?

Epidemiology 

• What’s been the trend in pediatric firearm injuries over the past 10 years? 
• Do we have any idea how/why these are occurring (ie, accidental, intentional, etc)

Terminology: For those unfamiliar with firearms (table 1)

Ballistics: Mechanisms of damage. 

Pre-hospital care

• Trauma center transport
• Prehospital hemorrhage control -- Combat application tourniquet, anything else? 

ED Evaluation

• SIPA -- What is it and why use it? 
• Primary survey -- Tachycardia -> delayed cap refill -> hypotension in children? 
• Secondary Survey
• Diagnostic Studies: 
• Damage Control Resuscitation
• Wound Care -- Do we remove projectiles? Can they stay in? 
• Antibiotics 
• Joint Involvement
• Compartment Syndrome -- 3 As vs 6 Ps
• Rhabdomyolysis

Controversies

• CTA for all injuries? 
• Hemostatic devices -- Any role for these in the ED?