This episode of the podcast is a live recording from the PREMIER Conference of John O Neil discussing penetrating injuries with learning points that are useful for clinicians who look after both adult and paediatric patients.
There are three main mechanisms – violence, impalement and self harm, although the first is by far the most common.
Penetrating injuries are rare but have significant morbidity and mortality. The key is early and accurate diagnosis, and many can be managed conservatively. The distribution of penetrating injuries across the UK differs widely, with most in the London area, although as seen in the news recently can happen anywhere.
Remember how traumatic it is to be a trauma patient. We put you on a bed, cut off your clothes, stick needles in you and take your family away. Some will also just not engage with you (teenage boys particularly) making assessment difficult. Be kind. Don’t get frustrated.
Physiologically there may be a strong vagal response that can hide some of the signs we’d expect. Also, bear in mind the events prior to the injury – the child may have been running a considerable distance (before and after the incident) raising their lactate (but don’t assume this is the cause). Children tend to ‘fall off a cliff’ – they appear well, but can suddenly decompensate – keep the momentum to definitive management going and do not be falsely reassured.
John mentioned a great friend of St Emlyn’s Vic Brazil and we would heartily endorse you have a look at her work.
You can find more information about the Reducing Knife Crime initiative here
Ep 54 - A tribute to John Hinds
Ep 53 - Day 2 and 3 Round Up (SMACCUS)
Ep 52 - Managing grief in the ED with Liz Crowe
Ep 51 - Day One Round Up (SMACCUS)
Ep 50 - All in a day's work (SMACC 2015)
Ep 49 - SMACC Workshops Review and Pearls
Ep 48 - Intro to EM: The patient with back pain.
Ep 47 - Barbra Backus on Risk scores in Acute Coronary syndromes
Ep 46 - Intro to EM: The patient with asthma
Ep 45 - Top 10 trauma papers 2014-2015.
Ep 44 - Tim Draycott on Obstetric Trauma (LTC 2014)
Ep 43 - APLS 2015 updates for the management of the serious injured child
Ep 42 - Paediatric Major Trauma with Ross Fisher (LTC 2014)
Ep 41 - Is trauma an elite sport? with Tom Evens (LTC 2014)
Ep 40 - Opiate overdose in the ED
Ep 39 - Prof. Tim Harris on Shock Assessment (LTC 2014)
Ep 38 - New (or are they really new) Oral Anticoagulants and the Emergency Physician PART 2
Ep 37 - Karim Brohi at LTC (LTC 2014)
Ep 36 - The GoodSAM app with Mark Wilson (LTC 2014)
Ep 35 - New (or are they really new) Oral Anticoagulants and the Emergency Physician PART 1
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