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JUST THE FACTS IN EMERGENCY MEDICINE - PART 9

tiềm ẩn chấn thương. Những chấn thương phổ biến nhất là đụng dập phổi, mà có thể không được hiển thị trên ngực ban đầu radiograph.8 mức amylase Tăng có liên quan với chấn thương của tuyến tụy và bowel.9 lá lách, gan | 474 SECTION 20 TRAUMA underlying injury. The most common injury is pulmonary contusion which may not be visible on the initial chest radiograph.8 Elevated amylase levels are associated with injuries of both the pancreas and bowel.9 The spleen followed by the liver is the most commonly injured abdominal organ in children. Handlebar injuries often cause isolated pancreatic trauma.10 Pelvic fractures particularly anterior ring fractures are associated with urethral and bladder injury. The degree of hematuria correlates with the severity of injury in genitourinary trauma although disruption of the renal pedicle may not be associated with hematuria.11 DIAGNOSIS AND DIFFERENTIAL The process of evaluating victims of trauma is the same for both children and adults the primary and secondary surveys are completed in a systematic fashion. The imaging modality of choice for the evaluation of head injury is the computed tomography CT scan indications for ordering this test include significant loss of consciousness deteriorating level of consciousness neurologic deficits apparent skull fracture on physical examination persistent nausea and vomiting and seizure. A high clinical suspicion must be maintained for SCIWORA and high cervical spine injury in the younger child. Physical examination findings consistent with spinal cord injury or abnormalities on spine radiographs are strong indications for CT scanning. In the evaluation of abdominal injury in the pediatric patient the physical examination has both a high false-positive and relatively high false-negative rate. Therefore either CT scanning or diagnostic peritoneal lavage primarily for hemody-namically unstable patients is utilized frequently. CT scan is also indicated for patients with genitourinary trauma demonstrating as few as 20 red blood cells per high-power field. Cystourethrography is required for all patients with suspected injuries of the lower urinary tract. EMERGENCY DEPARTMENT CARE And disposition Airway .