ECMO-/ECLS

For thoracic trauma, particular attention should be directed to the neck and
chest. Physical examination should include auscultation, visual inspection,
manual palpation, and percussion of the chest wall. Depending on the
mechanism of injury, particularly blunt trauma, the physical exam may not
demonstrate outward signs of injury. Therefore, a chest x-ray is indicated if
there is a clinical history of a high-risk mechanism for trauma, or if there is any
clinical signs of chest injury present on the child.
A surveillance anterio-posterior chest X-ray can be obtained without
significant difficulty in a supine, immobilized patient. The x-ray should be
examined systematically to evaluate for pleural injury, pulmonary contusions,
mediastinal abnormalities, and rib fractures. If findings on chest x-ray are
inconclusive for hemothorax or pneumothorax, the study can be supplemented
with a bedside ultrasound of the chest. Positive findings for pleural injury or
effusion warrants management with chest tube thoracostomy. Other chest x-
ray findings for thoracic injury, including rib fractures and pulmonary
contusions, should prompt admission for pain control and pulmonary hygiene.
If rib fractures present or the patient history is not congruent with the patient’s
presentation, social work involvement may be necessary to assess for possible
child abuse.
Mediastinal abnormalities on chest x-ray or clinical history of high speed
acceleration-deceleration traumas warrant further imaging in a
hemodynamically stable patient. Computed tomography angiography should
be performed in these select cases to efficiently evaluate for aortic,