Serious Injuries Discovered Later

Pulmonary contusion

Children have a high incidence of pulmonary contusion because of the mobility of the ribs. There may be no overlying fracture.This injury is usually the result of blunt trauma which ruptures pulmonary capillaries allowing blood to fill the alveoli, causing the child to become hypoxic.

Diagnosis is often by exclusion. "Consolidation" may be seen on chest radiograph, but this investigation may be normal. Treatment consists of the administration of high-flow oxygen, and artificial ventilation if necessary.

Tracheal and bronchial rupture

Frequently lethal, this presents as a pneumo- or haemopneumothorax, possibly with associated subcutaneous emphysema.

Resuscitation treatment is as described above. Continued significant air leaks after chest drain insertion strongly suggest this diagnosis. Definitive care requires referral to a cardiothoracic surgeon.

Disruption of great vessels

This is usually rapidly fatal. A child with this injury who survives to get to hospital has a tear in a vessel that has tamponaded itself. The patient may be shocked and peripheral pulses may be poorly palpable. The diagnosis should be suspected if a widened mediastinum is seen on chest radiograph. A radiologist should be called to perform urgent angiography. Definitive treatment is by a cardiothoracic surgeon.

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