Pediatric emergency medicine trisk 3712 3712

FIGURE 115.7 Pericardiocentesis is performed by inserting a 20-gauge spinal needle below
the xiphoid process at a 45-degree angle toward the left shoulder.

Disposition
In one study, all children who developed heart failure or life-threatening cardiac
arrhythmias during their hospital course initially presented to the ED either in
shock or with an arrhythmia. Based on this, patients with suspected isolated
myocardial contusion can be monitored in the ED or hospital. If no arrhythmias
develop on EKG, they can be safely discharged home. Children with any
arrhythmia require admission to a bed with continuous cardiac monitoring. More
significant cardiac injuries necessitate admission to an intensive care unit, with
interventional cardiologists or cardiac surgeons available to provide emergent
interventions as needed.

INJURIES OF THE AORTA AND GREAT VESSELS
CLINICAL PEARLS AND PITFALLS