Pediatric emergency medicine trisk 3429 3429

Shock is uncommonly caused by blood loss from a fracture, except in
the setting of extensive pelvic fractures or multiple long bone fractures;
therefore, the presence of other injuries should be evaluated if shock is
present.
After the initial trauma evaluation and resuscitation, a thorough
secondary survey is important to identify other possible orthopedic as
well as nonorthopedic injuries.
Thoracic and lumbar spine fractures are challenging to diagnose by
physical examination in the setting of multisystem trauma. If the injury
mechanism or examination is concerning for possible spinal injury,
radiographs should be obtained and careful immobilization maintained.
In the setting of multisystem trauma, fractures may be common and sometimes
are the most obvious injury, but they are rarely life-threatening. The usual trauma
evaluation and resuscitation protocol should be followed for any child with
concern for multisystem trauma and/or a severe mechanism of injury. After the
child has been stabilized, the injured extremity should be immobilized. For
unstable pelvic injuries with associated bleeding, wrapping the pelvis tightly in a
sheet or the application of an external fixator device may help tamponade the
bleeding.