in the emergency room. A normal EKG requires no further cardiac evaluation or
monitoring and the patient may be discharged home with pain medication. An
abnormal EKG, on the other hand, warrants an admission for 24-hour cardiac
monitoring and pain control.
Fracture of the scapula is also uncommon in children. Blunt force
trauma is the most common mechanism injury. A significant amount of energy
transfer is required in order to fracture the scapula and associated injuries are
seen in 90% of patients with this injury. The most common related injury is
pulmonary contusion. Scapular fractures that are non-displaced can be
managed non-operatively with a sling, while surgical intervention may be
required for deformed or significantly displaced fractures.
F. Tracheobronchial Injuries
Tracheobronchial injuries in children are rare, occurring in less than 1%
of pediatric traumas. Although rare, these injuries have a 30% mortality and
half of the deaths occur within the first hour of injury. Disruption of the trachea
or bronchi may result from a direct penetration injury or from high energy blunt
chest trauma. The most common causes of tracheobronchial injuries are motor
vehicle accidents, pedestrian accidents, and falls. Mechanisms for airway
rupture in blunt trauma include abrupt increase in intraluminal pressures from
chest compression with a closed glottis, violent acceleration-deceleration of the
tracheobronchial tree and lungs, or anterio-posterior compression of the
sternum against the spine causing sudden displacement of lungs laterally. Up