1984).īarotrauma: Various forms of CPR-related barotrauma have been described in children (Cullen 2001). Note if abdominal compressions were performed (Waldman et al. Rib fractures are discussed further in the latter portion of this chapter.Īlthough extremely rare, compressions in children may result in pancreatic hemorrhage, hepatic/splenic contusion or laceration, retroperitoneal hemorrhage, and gastric perforation (Bush et al. Rib fractures secondary to CPR are rarely reported and are more often the result of inflicted trauma (Bush et al. Epicardial hematoma, pleural petechiae or ecchymosis, and pulmonary interstitial hemorrhage can also occur (Bush et al. Thorax and Abdomen: Chest compressions can result in midsternal abrasions and/or slight contusions. Traumatic mucosal tears and hypopharyngeal perforation have occurred and are not uncommon (Galvis and Kelley 1979). The child’s oropharynx is more susceptible to damage by forceful digital clearing and suction as well as by endoscopic instruments (Figs. Teeth can also be broken during intubation. The lips may be contused or lacerated from the victim’s own teeth or by the endotracheal tube (Fig.
![signs of rib trauma in a toddler signs of rib trauma in a toddler](https://i.pinimg.com/736x/92/7f/8f/927f8f8499000a270ba0d8692cad2ba2--athletic-training-neck-pain.jpg)
Intubation can result in abrasions and/or contusions of the oropharynx, gingiva, buccal mucosa, frenulum, epiglottis, base of the tongue, larynx, and trachea. If a mask is not used but instead mouth-to-mouth, one may see scrapes/fingernail scratches over the perinasal area. As the resuscitator positions his/her hand on the child, fingertip contusions beneath the chin and on the side of the head may be produced. These include facial abrasions (nasal bridge, undersurface of the nose, anterior chin) from the air-bag-valve mask, which are usually symmetrical. Head and Neck: Most CPR-related injuries in children are soft tissue injuries of the head and neck from ventilatory efforts (Kaplan and Fossum 1994). In other studies, injuries were noted, but none were significant or abdominal (Matshes and Lew 2010a, b Price et al. It must be noted that some studies of many resuscitated children report no injuries. If available, the exact mask used during the resuscitation should be retained. A doll can be used as well as the same type and size of mask. The investigator can correlate injuries with points of contact during compressions and ventilation. The emergency medical services (EMS) personnel or physician can easily demonstrate how he/she performed CPR. The techniques include one-handed compressions (“two finger”), two-handed compressions (“two-thumb-encircling hands”), and abdominal compressions. One should be aware of the resuscitative technique used on children and note if the resuscitator is experienced in this technique (Reyes et al. These injuries are due to the compressions and to ventilation/intubation.
![signs of rib trauma in a toddler signs of rib trauma in a toddler](https://clinmedjournals.org/articles/ijsem/ijsem-7-193-002.jpg)
Most CPR injuries involve the head/neck and rarely the thorax and abdomen. It is best to divide the injuries into categories: head and neck, thorax and abdomen, barotrauma, and iatrogenic artifacts. Such injuries may be external and/or internal. 1996 Plunkett 2006 Matshes and Lew 2010a Ryan et al. Injuries secondary to CPR are usually pathophysiologically insignificant (Bush et al.