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 92 - The Teaching Course Copenhagen Day 1
Ep 91 - Critical Appraisal Nugget 7: Relative risk, Absolute risk and NNT in 5 minutes
Ep 90 - Top Ten Trauma Papers 2016
Ep 89 - March 2017 Round Up
Ep 88 - ED transfers. Patient, Preparation and People.
Ep 87 - Critical Appraisal Nugget 6: Retrospective and Prospective studies
Ep 86 - Critical Appraisal Nugget 5: Journal Clubs
Ep 85 - Top tips for chest drains.
Ep 84 - Critical Appraisal Nugget 4: Intention to Treat
Ep 83 - The Teaching Course in NYC Round Up
Ep 82 - Apparent Life Threatening Events in Babies
Ep 81 - Difficult Conversations with Children in Critical Care with Liz Crowe
Ep 80 - EuSEM Half Time Talk
Ep 79 - Critical Appraisal Nugget: Selection Bias
Ep 78 - Intro to EM: Upper GI bleeding
Ep 77 - Critical Appraisal Nugget 2: Blinding and Masking in clinical trials
Ep 76 - Communication workshop with Liz Crowe (SMACC DUB)
Ep 75 - Critical Appraisal Nugget 1: Randomisation
Ep 74 - ED Handover in the resus room: A panel discussion at SMACC DUB. (Part 2)
Ep 73 - ED Handover in the resus room: A panel discussion at SMACC DUB. (Part 1)
Create your
podcast in
minutes
It is Free
The Relaxback UK Show
Good Nurse Bad Nurse
On Call With Dr. Anselm Anyoha
The Doctor’s Farmacy with Mark Hyman, M.D.
The Peter Attia Drive