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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 (https://www.ebmedicine.net/topics/tra...) . 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?