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

Bullet Fragmentation and Path

(Chesney, 2004)

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.