CJEM Articles: injury pattern

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  • All-terrain vehicle major injury patterns in children: a five-year review in Southwestern Ontario
    July 2006 8 4
    Khalid Alawi, Rod Lim, Tim Lynch

    Objective: The aim of the study was to characterize the nature of the injuries sustained by children involved in all-terrain vehicle (ATV) crashes in Southwestern Ontario over a 5-year period.
    Methods: A retrospective chart review was conducted of children who sustained ATV-related trauma and who presented to the emergency department at the Children's Hospital of Western Ontario between Sept. 1, 1998, and Aug. 31, 2003, with an Injury Severity Score (ISS) = 12. Patients were identified by the London Health Sciences Centre Trauma Program Registry. Patient charts were then retrieved and reviewed to record patient demographics, injuries, interventions and length of stay in hospital.
    Results: Seventeen patients, 14 male and 3 female, met inclusion criteria. Ages ranged from 8–17 years, with an average age of 13.7 years. Thirteen were <16 years of age. Overall there were 7 different systems injured in these 17 patients. Fourteen patients sustained an injury to more than 1 system. The average ISS was 22.8. The average length of hospital stay was 9.7 days. Six patients sustained significant head injuries; 4 of these 6 patients were not wearing helmets. Eight patients suffered splenic injuries, and 3 required a splenectomy. Thirteen patients sustained fractures.
    Conclusion: ATV trauma is a significant threat to the children in Southwestern Ontario. These results clearly support the Canadian Paediatric Society's recommendation that children <16 years of age should be prohibited from operating or riding on ATVs.

  • Impact of a pressure-responsive flow-limiting valve on bag–valve–mask ventilation in an airway model
    May 2006 8 3
    Jonnathan M. Busko, Thomas H. Blackwell

    Objective: Using a simulated airway model, we compared ventilation performance by emergency medical services (EMS) providers using a traditional bag–valve–mask (Easy Grip®) resuscitator to their performance when using a new device, the SMART BAG® resuscitator, which has a pressure-responsive flow-limiting valve.

    Methods: We recruited EMS providers at an EMS educational forum and performed a randomized, non-blinded, prospective crossover comparison of ventilation with 2 devices on a non-intubated simulated airway model. Subjects were instructed to ventilate a Mini Ventilation Training Analyzer® as they would an 85-kg adult patient in respiratory arrest. After being randomized to order of device use, they performed ventilation for 1 minute with each device. Primary outcomes were ventilation rates and peak airway pressures. We also measured average tidal volume, gastric inflation volume, minute ventilation and inspiratory:expiratory (I:E) ratio, and compared our results to the American Heart Association standards (2005 edition).

    Results: We observed statistically significant differences between the SMART BAG® and the traditional bag–valve–mask for respiratory rate (12 v. 14 breaths/min), peak airway pressure (15.6 v. 18.9 cm H2O), gastric inflation (239.6 v. 1598.4 mL), minute ventilation (7980 v. 8775 mL), and I:E ratio (1.3 v. 1.1). Average tidal volume was similar with both devices (679.6 v. 672.2 mL).

    Conclusion: The SMART BAG® provided ventilation performance that was more consistent with American Heart Association guidelines and delivered similar tidal volumes when compared with ventilation with a traditional bag–valve–mask resuscitator.