Post on 12-Jan-2016
Firearms Injuries in the Pediatric PatientShannon Gaines RN, BSN, CPEN
PurposeThis presentation aims to provide the nurse
with an overview of firearms injuries. The presentation will review the statistics related to gunshot wounds and the types of injuries that result from gunshots. Further, this presentation will discuss the emergent management of the patient with a gunshot injury.
Objectives
By the end of the lecture the audience will:
Review national statistics related to gunshot injuries in pediatric patients
Discuss risk factors for age groups.
Review factors that would increase injury or fatality
Review management of gunshot wound injuries
Review cases and management of patient seen in CHOP resuscitation room
Discuss prevention of injury from guns.
GSW StatisticsFirearm injuries
account for 4.5% of all
traumatic injuries
12 % of fatalities related to trauma
Gunshot Wounds are the 5th leading cause of fatality in pediatrics
Case Fatality Rate
Fall MVA Struck by, against
Transport, other
Firearm Pedal cyclist, other
0
2
4
6
8
10
12
14
Case Fatality Rate %
Case Fatality Rate %
Injuries Related to GSWsMost common Injury:
ThoraxAbdomenPelvis
Most common FatalityCranial
(Mikrogianakis, 2010)
Important Information
Certain factors make a GSW more or less significant
1. Type of gun
2. Number of shots
3. Patient position
4. Distance from gun
(Chesney, 2004)
Injury will result from
1. Velocity
2. Tissue penetration
3. Fragmentation of bullets
Age-Related Risk FactorsToddler and School-
Aged Adolescents
(Dowd, and Sege, 2012; Reich, Curloss, Behrman, 2002)
GSW Management
Initial Assessment
Primary Survey
A- airway
B- breathing
C- circulation
D- disability
Secondary Survey Evaluate for lacerations,
bleeding, bruising or deformity to: Head Neck Chest Abdomen Extremities Rectum Perineum
ROLL THE PATIENT!!!!!
(Mikrogianakis, 2010)
Immediate Management
(Niven, and Castle, 2010; Hanlon, and Srivastava 2012)
Abdominal Trauma
Tumbling track of bullet
May be contaminated with bowel content
HEMODYNAMICS
ANTIBIOTICS
OR Washout Repair Bullet removal
(Miller, Carroll, and Pilson (2013))
Thorax Trauma
Airway
Breathing Equal breath sounds bilateral
Circulation CPR Is the heart filling?
(Reeder, and Danis, 2001; Kerr, and Maconochie, 2008)
Pelvic Trauma
Normally associated with abdominal trauma
Requires Bullet removal Clean out of wound
(Miller, Carroll, and Pilson (2013))
Cranial Trauma
Most fatal of all firearms injuries
PRIMARY SURVEY
SECONDARY SURVEY
? Foreign body removal or wound debridement
Prophylactic medications Antibiotics Anti-epileptics
Kazim, Shamim, Tahir, Enam, and Waheed, 2010)
Vascular Damage
Hemodynamics
Pressure
Tourniquet
OR for repair
(Niven, and Castle, 2010)
Screen families for guns in the home
EDUCATE!!
Questions?
References Chesney, M. (2004). Pediatric firearms injuries. Pediatric Perspectives. 23.6. p. 10-13.
Dowd, D., and Sege, R. (2012). Firearm-related injuries affecting the pediatric population. American Academy of Pediatrics. 130.5. p. 1416-1422.
Hanlon, D., and Sirvasta, A. (2012). Gunshot wounds: Management and Myths. Trauma Reports.
Kerr, M., and Maconochie, I. (2008). Pediatric chest trauma (part 1)- initial lethal injuries. Trauma. 10. p. 183-194.
Kountakis, S., Rafie, J., Ghorayeb, B., and Stiernberg, C. (1996). Pediatric gunshot wounds to the head and neck. Otolaryngology- Head and Neck Surgery.
Mikrogianakis, A. (2010). Penetrating abdominal trauma in children. Clinical Pediatric Emergency Medicine. 11.3. p. 21-224
Miller, A., Carroll, E., Tyler-Paris Pilson, H. (2013). Transabdominal gunshot wounds of the hip and pelvis. Journal of the American Academy of Orthopaedic Surgeons. 5. p. 286-294.
Nivens, M., and Castle, N. (2010). Use of tourniquets in combat and civilian trauma situation. Emergency Nurse. 18,3. p. 32-36.
Reeder, R., and Danis, D. (2001). Penetrating chest trauma. American Journal of Nursing. 101.9. p. 15-18.
Reich, K., Culross, P., and Behrman, R. (2002). Children, youth, and gun violence: Analysis and Recommendations. Children, Youth, and Gun Violence. 12. 2. p. 5-23.