1. Firearms Injuries in the Pediatric Patient Shannon Gaines RN, BSN, CPEN

2. Purpose  This presentation aims to provide the nurse with an overview of firearms injuries. The presentation will review the statistics related to gunshot wounds and the types of injuries that result from gunshots. Further, this presentation will discuss the emergent management of the patient with a gunshot injury.

3. Objectives By the end of the lecture the audience will:  Review national statistics related to gunshot injuries in pediatric patients  Discuss risk factors for age groups.  Review factors that would increase injury or fatality  Review management of gunshot wound injuries  Review cases and management of patient seen in CHOP resuscitation room  Discuss prevention of injury from guns.

5. GSW Statistics  Firearm injuries account for  4.5% of all traumatic injuries  12 % of fatalities related to trauma  Gunshot Wounds are the 5 th leading cause of fatality in pediatrics

6. Case Fatality Rate

7. Injuries Related to GSWs  Most common Injury:  Thorax  Abdomen  Pelvis  Most common Fatality  Cranial (Mikrogianakis, 2010)

8. Important Information  Certain factors make a GSW more or less significant 1.Type of gun 2.Number of shots 3.Patient position 4.Distance from gun (Chesney, 2004)

9. Injury will result from 1.Velocity 2.Tissue penetration 3.Fragmentation of bullets

10. Bullet Fragmentation and Path (Chesney, 2004)

11. Age-Related Risk Factors Toddler and School-AgedAdolescents (Dowd, and Sege, 2012; Reich, Curloss, Behrman, 2002)

12. GSW Management

13. Initial Assessment Primary Survey  A- airway  B- breathing  C- circulation  D- disability Secondary Survey  Evaluate for lacerations, bleeding, bruising or deformity to:  Head  Neck  Chest  Abdomen  Extremities  Rectum  Perineum ROLL THE PATIENT!!!!! (Mikrogianakis, 2010)

14. Immediate Management (Niven, and Castle, 2010; Hanlon, and Srivastava 2012)

15. Abdominal Trauma  Tumbling track of bullet  May be contaminated with bowel content  HEMODYNAMICS  ANTIBIOTICS  OR  Washout  Repair  Bullet removal (Miller, Carroll, and Pilson (2013))

16. Thorax Trauma  Airway  Breathing  Equal breath sounds  bilateral  Circulation  CPR  Is the heart filling? (Reeder, and Danis, 2001; Kerr, and Maconochie, 2008)

17. Pelvic Trauma  Normally associated with abdominal trauma  Requires  Bullet removal  Clean out of wound (Miller, Carroll, and Pilson (2013))

18. Cranial Trauma  Most fatal of all firearms injuries  PRIMARY SURVEY  SECONDARY SURVEY  ? Foreign body removal or wound debridement  Prophylactic medications  Antibiotics  Anti-epileptics Kazim, Shamim, Tahir, Enam, and Waheed, 2010)

19. Vascular Damage  Hemodynamics  Pressure  Tourniquet  OR for repair (Niven, and Castle, 2010)

20.  Screen families for guns in the home  EDUCATE!!

21. Questions?

22. References  Chesney, M. (2004). Pediatric firearms injuries. Pediatric Perspectives. 23.6. p. 10-13.  Dowd, D., and Sege, R. (2012). Firearm-related injuries affecting the pediatric population. American Academy of Pediatrics. 130.5. p. 1416-1422.  Hanlon, D., and Sirvasta, A. (2012). Gunshot wounds: Management and Myths. Trauma Reports.  Kerr, M., and Maconochie, I. (2008). Pediatric chest trauma (part 1)- initial lethal injuries. Trauma. 10. p. 183- 194.  Kountakis, S., Rafie, J., Ghorayeb, B., and Stiernberg, C. (1996). Pediatric gunshot wounds to the head and neck. Otolaryngology- Head and Neck Surgery.  Mikrogianakis, A. (2010). Penetrating abdominal trauma in children. Clinical Pediatric Emergency Medicine. 11.3. p. 21-224  Miller, A., Carroll, E., Tyler-Paris Pilson, H. (2013). Transabdominal gunshot wounds of the hip and pelvis. Journal of the American Academy of Orthopaedic Surgeons. 5. p. 286-294.  Nivens, M., and Castle, N. (2010). Use of tourniquets in combat and civilian trauma situation. Emergency Nurse. 18,3. p. 32-36.  Reeder, R., and Danis, D. (2001). Penetrating chest trauma. American Journal of Nursing. 101.9. p. 15-18.  Reich, K., Culross, P., and Behrman, R. (2002). Children, youth, and gun violence: Analysis and Recommendations. Children, Youth, and Gun Violence. 12. 2. p. 5-23.