Monday, March 9, 2015


Oops - this case was scheduled to post last Thursday but didn't trigger.

A child is brought in by ambulance as a major trauma. He was hit by a slow moving car which pinned him against the wall. When EMS found him, his chest was pinned against the bumper. There was no injury at the neck. He is stable on your primary survey of airway, breathing, circulation, disability, and exposure. On your secondary trauma survey, you note bilateral conjunctival hemorrhage, facial edema, ecchymoses, and petechiae on the upper chest and face. Fortunately, the prognosis for this is generally favorable.

Challenge: What happened?


RaH said...

sounds like typical injuries in strangulation patients.. which are caused by the obstruction of venous return by compression of vessels.
my guess would be a subtotal venous return obstruction during the compression between car and wall. the signs are caused by the increased capillary pressure and extravasation of the small and fragile facial vessels. the ecchymoses are due from the impact or from the compression of the car.
lucky kid, slow car impacts usually result in the kids being rolled over by multiple tires, and bad injuries.

PS: would be nice to get the answer to the other cases...

Craig Chen said...

great reasoning!

This is traumatic asphyxia, more common in children because of greater flexibility of their thoracic cages. Increased intrathoracic pressure occurs due to direct compression of the chest along with deep inspiration against a closed glottis. This can cause rupture of venules and capillaries in the face and head.

Source: UpToDate.