Karina Arrieta Posada Georgina Penagos Hollmann Manuel David Torres Guzmán

 Introduction  Materials and Methods  Results  Discussion  Conclusions  Questions

 Introduced to complement the protection provided by safety belts.  This protective feature can be detrimental to infants and children: - 49 deaths in the United States as of November 1, Reported 73 pediatric fatalities resulting from airbag deployment (15 were infants).

 Establish if unrestrained children in the front passenger seat were at greater risk of airbag deployment trauma than unrestrained children.

 The records of all children evaluated and treated at: - Rainhow Babies & Children’s Hospital (Cleveland). - Children’s Hospital (Columbus). - Children’s Hospital Medical Center (Cincinnati).

 Demographic: injury, and crash data were obtained from: - Medical Emergency Services - Hospital Records - Coroners´ Reports.

 27 children.  Age: 1 month - 12 years M A: 5.1 SD:3.34  Airbag injuries: 1 of 3 regional pediatric trauma centers  61% Girls  ISS: M 10 SD: 14.5  Speed: < 45 mph

 Airbags reduce the morbidity in adults.  Passenger side airbag increases airbag-related injuries in children.  The severity of injury depends on the proximity to the point of explosive airbag impact.  The pattern and severity within injury classifications differed with age and size of the children.

 The abdominal organ injuries were exclusive to the restrained group.  We encountered an overall mortality rate of 7.4%. Of which, one half were restrained properly.  Isolating small children from the path of an airbag can be problematic when they are transported in vehicles without rear-seating capability.

 The National Highway Trafic Safety Administration recommends that children 12 years of age or younger be properly restrained in the rear seat of a motor vehicle.

 Nonpenetrating chest trauma with injury to the heart and aorta has become increasingly common  high-speed vehicular accidents, Airplane crashes, falls from height, and other severe crushing injuries of the tórax Cardiac Injuries by Blunt Trauma

 Incidence of cardiac injury is 20% after blunt chest trauma in postmortem studies  Pediatric age group, incidence is slightly lower and previous studies suggested that cardiac injury was found in 15–20%  Incidence for all age groups might be as low as 0.5–0.8% in clinical studies

 The majority of patients die before they arrive at the emergency department  The great majority of cardiac injuries are still diagnosed by systemic autopsy  Male:female ratio 3.5:1

 Retrospective analysis of 1597 autopsies of fatalities associated with blunt trauma in Itanbul form 2001 to 2003

 11.9% (190) had cardiac injuries  45.2% (85) cardiac injuries were cause of death  56% (106) injured by vehicle accidents  38% (72) injured by fall  13% (25) were alive on arrival to the emergency department ▪ Survival time less than 24h: 56% (14) ▪ Survival time greater than 24h: 44% (11)

 11.9% (190) had cardiac injuries  Accompanied by: ▪ Pulmonary contusions 44.2% (84) ▪ Sternal fractures 62% (32.6%) ▪ Serious head injuries 41.6% (79)

Pericardial Tearing 27.3% (52) Injury of great vessels 28.8% (15) Atrial and/or ventricular rupture 38.5% (20)

Myocardial Ruptures and Contusions Right atrium Rupture 15.8% (30) Left atrium Rupture 11.1% (21) Right ventricle Rupture 22.6% (43) Left Ventricle Rupture 23.2% (44) Right Wall Contusions 12.1% (23) Left Wall Contusions 8.9% (17)

Other Injuries Coronary artery injuries 2.6% (5) Heart valve injuries 3.6% (7), predominantly tricuspid and aortic Heart completely torn off at the base 5.2% (10)

 Mechanism: direct impact to the chest wall with transmission of the kinetic force to the patient, causing compression of the heart between the sternum and the spine  ‘‘Hydraulic Ram Effect’’  Atria and ventricles appear to be more vulnerable to these compressive forces

 A number of factors affect the spectrum of cardiac injury:  force applied to the chest  compliance of the chest wall  exact timing of the application of force during the cardiac cycle  Pericardial injuries are the most common findings of blunt cardiac trauma

 Higher impact traumas, such as motor vehicle accidents, falls, and explosions might be responsible for injuries such as transmural ruptures

 Airbags are an efficacious safety feature in automobiles, but are the cause of injuries to children regardless of whether the child is properly restrained  Injury prevention strategies should focus on the proper use of child restraints coupled with placing children in the rear seat

 Closed Chest trauma must make physicians consider traumatic cardiac lesion  Possibility of concomitant injuries (lung, heart, trachea, bronchus, and esophagus)

 A close clinical evaluation, ECG monitoring, transthoracic, and transesophageal echo examinations, even cardiac enzyme analysis (CKMB, Tn T, Tn I levels) are mandatory  Traffic events = Spectre of death possibilities; driver responsability is adviced