Blunt chest trauma in children ED management

AP: anterior-posterior; CT: computed tomography; CXR: chest x-ray; ECG: electrocardiogram; ED: emergency department; e-FAST: Extended Focused Assessment with Sonography in Trauma; OR: operating room; PA: posterior-anterior; PTX: pneumothorax; TEE: transesophageal echocardiography; US: ultrasound.
* e-FAST includes is a rapid bedside ultrasound examination of four abdominal locations: right upper quadrant, left upper quadrant, subxiphoid region, and pelvis; lungs; and heart.
¶ Aortic injury should be suspected in children with a rapid deceleration injury (eg, high-speed motor vehicle crash or fall from a significant height), hypotension, diminished blood pressure or pulses in the lower extremities compared to the upper extremities, or paraplegia. Tracheobronchial injury should be suspected in children with subcutaneous emphysema, stridor, and/or a persistent high volume air leak from a chest tube placed for a pneumothorax. Refer to UpToDate topics on intrathoracic injuries in children.
Δ Chest radiograph findings of aortic injury include a widened superior mediastinum, a left apical cap (fluid from left mediastinum to the apex), abnormal aortic knob contour, and/or a left hemothorax or pleural effusion. Chest radiograph findings of a tracheobronchial injury include air within soft tissue surrounding a bronchus or pneumothorax, hyoid bone elevation suggesting tracheal transection, or obstruction of an air-filled bronchus. Refer to UpToDate topics on intrathoracic injuries in children.