SAQ 412 – Trauma – paediatric penetrating chest injury

Trauma – paediatric penetrating chest injury.

a. Photograph description

• Penetrating injury to the right lower anterior chest, around the nipple line/lower intercostal spaces.
• Knitting needle remains in situ, approximately perpendicular to the chest wall, with foreign material at the entry site.
• Depth cannot be assessed from the photograph.
• The child appears comfortable, cooperative, well perfused, and not in obvious distress.
• Chest expansion appears approximately equal.

b. Possible complications

• Tension pneumothorax.
• Simple pneumothorax.
• Haemothorax.
• Hepatic injury.
• Diaphragmatic injury.
• Intercostal or other vascular injury.
• Intra-abdominal visceral injury such as gastric or bowel injury.
• Infection or empyema.
• Cardiac injury or tamponade, although less likely from the location.

c. Management priorities

• Decompress the right chest if tension pneumothorax is suspected.
• Resuscitate with oxygen and an appropriate fluid bolus, followed by blood if haemorrhagic shock is suspected.
• Give analgesia.
• Leave the needle in situ.
• Arrange urgent surgical review and removal in theatre.