Iím curious what others are doing for Pediatric Trauma patients with intra-abdominal injuries (e.g., liver or spleen laceration) who need fracture reduction. Normal kid, no other injuries (detailed example below)
1) Ketamine & Ortho reduction in ED?
-if so is Ketamine-induced tachycardia a concern?
-Is ketamine-induced BP elevation a risk to worsen intra-abdominal bleeding?
2) Other agent & Ortho reduce in ED?
3) Ortho reduction under sedation in PICU?
4) OR management Ortho & Anesthesia?
Thanks for playing along
There are many different varieties of this description, but letís say itís the following scenario (& this is not an invitation for commentary on trauma imaging...an entirely different conversation):
7yo patient previously healthy, normal habitus without dysmorphismó high speed MVC with impact passenger side, lap+shoulder belt restrained rear-passenger, brief LOC, c/o right abdominal & right lower leg pain
-GCS 15, intact neuro, Head CT neg
-Facial abrasions, no oral injury, normal phonation, no secretion handling issues
-Cspine nontender, collar in place, CT neg
-Nl SpO2, slight tachypnea, symmetric breath sounds, CXR neg
-HR settles in 110s after analgesia & fluid bolus, normotensive (never hypotensive), well perfused
-Nondistended but R abd tenderness, CT shows Grade 3 Liver lac w/o extravasation, transaminases ~300, lipase normal, no RBCs on UA
-pelvis stable w/o fracture
-R midshaft tibia deformity, tender, intact distal neurovascular status, XR reveals 20 degrees angulated tib-fib fracture
no other lab/imaging abnormalities
Benjamin F. Jackson, MD
MUSC Ped Emerg Med
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