Once sudden cardiac arrest is identified, management should follow the
advanced cardiac life support algorithm. Chest compressions should be
initiated immediately and early utilization of automatic external defibrillators can
be lifesaving.
J. Aortic Injury
Traumatic thoracic aortic occurs in 0.05% to 0.1% of children with major
chest injuries. The mean age of children with blunt aortic injury is 12 years old,
and less than 10% occurs in children younger than 10 years of age. Motor
vehicle crashes are the most common cause of aortic injury and up to 85% of
patients die at the scene. The mechanism of thoracic aortic injury is thought to
be secondary to sudden deceleration of the mobile aortic arch against the fixed
descending aorta at the level of the ligamentum arteriosum, resulting in a sheer
injury distal to the left subclavian artery. Patients who survive to present to the
hospital often have multi-system injuries.
On physical exam, there are no specific signs of aortic injury. Thus, high
energy blunt trauma with rapid deceleration or multi-system injury should be
approached with a high degree of suspicion. A screening chest x-ray for
thoracic trauma may identify radiographic findings suggestive of aortic injury,
including a widened mediastinum, obscured aortic knob, “apical capping" or
pleural blood above the apex of the lungs, and depression of the left mainstem
bronchus. Concern for aortic injury should be further assessed with CT
angiography. Pseudoaneurysm is the most common CT finding, although