esophageal, or tracheobronchial tree injury. Aortic injuries require admission to
the intensive care unit for strict heart rate and blood pressure control.
Esophageal and tracheobronchial tree injuries require further endoscopic
examination and immediate surgical intervention.
An EKG should be done in children with physical or radiographic signs of
anterior chest trauma or an abnormal heart rhythm on the cardiopulmonary
monitor. A normal EKG in an asymptomatic patient requires no further
investigation. An abnormal EKG, on the other hand, requires an admission for
24 hour telemetry monitoring.
Hemodynamically stable patients, who are asymptomatic, without
significant mechanism of injury, and negative radiographic findings of
intrathoracic injury may safely be discharged. Otherwise, an injured child
should be admitted for cardiopulmonary monitoring, pain management, and
radiographic reassessment as indicated.
B. Hemodynamically Unstable Thoracic Trauma
In a hemodynamically unstable patient with altered mental status or
unresponsiveness, the airway should be secured immediately with
endotracheal intubation. Verification of proper tracheal intubation may be
established with the appreciation of symmetric bilateral breath sounds and
appropriate change in the end-tidal carbon dioxide detector. Fluid resuscitation
should be initiated with a 20 mL/kg bolus of isotonic crystalloid fluid such as
Lactated Ringers or normal saline. Access in hypotensive children less than 6