anterolateral thoracotomy or sternotomy, and the pericardium is opened sharply
with scissors taking care not to injure the phrenic nerve. Depending on the size
of the cardiac wound, a finger may be used to occlude the laceration. Repair is
then performed with nonabsorbable mattress sutures over Teflon pledgets. For
larger wounds, occlusion of laceration can be achieved by inserting a balloon
catheter into the wound and inflating the balloon with saline. Traction on the
catheter will stem bleeding temporarily to allow suture repair of the wound.
IV. PEDIATRIC THORACIC TRAUMA MANAGEMENT ALGORITHM
A. Hemodynamically Stable Thoracic Trauma
Pediatric trauma resuscitation begins with a primary survey to assess for
life-threatening conditions that demand immediate intervention. Establishing a
secure airway is the first priority in trauma resuscitation, followed by breathing
and circulation. Although there are levels of prioritization for the primary
survey, the patient assessment and execution of care are performed
simultaneously in a systematic and expeditious manner. Breath sounds are
assessed for symmetry and air movement, and cardiopulmonary monitoring is
established as peripheral intravenous access is established. As the patient is
quickly surveyed, life-threatening injuries should be identified and addressed
accordingly.
In a hemodynamically stable patient, once the primary survey is
determined to be intact, the exam should then proceed to the secondary survey
to sufficiently assess the patient from head to toe for external signs of injury.