Pediatric emergency medicine trisk 3405 3405

typically occur in the context of falls while straddling climbing structures in
playgrounds, sports equipment, or bicycles. The injuries may range from minor
lacerations and hematomas to penetrating extensive lacerations. These types of
injuries should also cue the emergency provider to consider sexual assault as a
cause (see Chapter 127 Sexual Assault: Child and Adolescent ).
In girls, vulvar hematomas or lacerations can occur as a result of a straddle
injury. It is essential to determine the extent of the injury before determining the
best repair, if any. If the injury is not fully visualized by the emergency provider
secondary to pain or blood obscuring the visualization, consultation with a
surgical specialist and/or examination under anesthesia are recommended. Vulvar
lacerations usually heal by secondary intention—topical antibiotics and sitz baths
help the healing process. For gaping, deeper lacerations which require primary
closure, the placement of absorbable sutures under procedural sedation or general
anesthesia is recommended. If a penetrating injury has led to a vaginal laceration,
a surgical consultation and consideration for examination under anesthesia are
recommended.
In boys, straddle injuries may lead to penile or scrotal lacerations. A thorough
genitourinary examination is required to determine the extent of injury. If injury
to the urethra is suspected, surgical specialty consultation is warranted and a
retrograde urethrogram is required. Superficial lacerations to the penile shaft and
scrotum can be repaired with absorbable sutures. Local anesthesia with a penile
block and/or procedural sedation may be required. Urology consultation is
recommended if the laceration involves the corporal body of the penile shaft or
urethra. Scrotal lacerations also result from sports-related injuries. Superficial
lacerations can be repaired with absorbable sutures but if the laceration extends to
the dartos layer or is penetrating, there is a risk of testicular injury and this
requires surgical specialty consultation in a timely manner.

VASCULAR INJURIES
CLINICAL PEARLS AND PITFALLS
Vascular injuries may present with a large hematoma, pulsating

bleeding, absent or diminished distal pulses, and color changes.
A thoughtful approach with adequate preparation and appropriate
consultation is required before exploring a potential vascular injury.