Pediatric Trauma II: Solid Organ Injury

This podcast is an interactive discussion about pediatric trauma between Dr. Todd Ponsky, Dr. Mark McCollum, and Dr. David Notrica. Dr. David Notrica is the trauma medical director at Phoenix Children's Hospital and is associate professor of surgery at the Mayo Clinic College of Medicine and Associate Professor of Surgery at the University of Arizona College of Medicine in Phoenix. 00:01:30 Dr. David Notrica 00:02:28 Can you tell us a little bit more about what ATOMIC is and what you guys did about it? 00:05:12 In patient with blunt solid organ injury, what is the evidence to support non-operative management based on hemodynamic status as opposed to a grade of injury? 00:07:45 Can you describe some of the other factors that we would use to define hemodynamic stability? 00:10:22 Do you use that in your center? Are the vital signs indexes like the shock index or laboratory values like serum lactate in addition to physical exam findings? 00:12:44 From a crystalloid infusion standpoint, what are your thoughts as far as limiting crystalloid infusion and patients that you know are actively bleeding not crystalloid, but bleeding blood? 00:15:57 What about the complications of transfusion short term and long term and how do we know that that is now not going up because we're giving more blood? 00:19:08 It seems like now real viscoelastic assays TEG and Rotem are getting a lot more traction so that we're directing component therapy specifically as opposed to shot gunning a transfusion. I would love your thoughts on that? 00:19:11 In a patient who has ongoing bleeding is he hemodynamically unstable and you're in the process of resuscitating them with blood products. What are your thoughts on angioembolization its safety and efficacy in pediatric of blunt liver and spleen injury? 00:22:05 So once we have these patients resuscitated and stable in kids with solid organ injury should ICU admission be determined then by injury grade, hemodynamics or a combination of both? 00:23:18 Do you have a threshold of volume of transfusion that would then indicate failure or is it a case by case? 00:24:33 What are your thoughts as far as time frame for bedrest? How long and what are the parameters that help you decide? 00:26:15 In hemodynamically stable patients, do you use a timeframe for observation or are they able to be fast tracked and may be discharged within 24 hours? 00:27:47 Do you have criteria or a threshold, Hematocrit or hemoglobin point that indicates lab variability versus actual continued bleeding? 00:29:31 So, whenever these kids are ready to go home, do you have a standard follow up regimen of a week, two weeks, four weeks. The rest issue I'll let you discuss as well, as far as time frame where they really stay off of activities until you see them back? 00:31:05 is there a type of injury a finding on imaging or a symptom that would then maybe move you to schedule additional imaging in follow up to avoid a complication like a pseudoaneurysm or AV fistula or something along those lines? 00:33:00 So, then it even in a grade 4 or a grade 5 injury with an active extravasation there's no real utility van and scheduling a post or a follow up ultrasound or additional imaging? 00:34:52 For a patient who is stabilized to the point that he is ready for discharge, what criteria do you use then for timeframe of follow up? 00:37:07 Review 00:41:23 Resources 00:43:11 Final comment