The purpose of this study was to identify the population of pediatric patients who arrive without signs of life and describe outcomes using a national database. Patients eighteen and younger with no signs of life were pulled from the National Trauma Database (NTDB) from the years 2007-2016. A total of N = 7503 patients were separated into two cohorts for comparison. Subset analysis was also conducted for patients undergoing a thoracotomy. Statistical analysis was performed on the collected data. Over the 9-year period most patients died in the ED or hospital (95.7%), very few patients were discharged home (1.3%), and ED thoracotomies were performed rarely (9%) with most patients dying (97%). Arrival to the trauma bay without signs of life is associated with a dismal prognosis. Clinical judgment must be carefully applied to choose the small number of patients who would benefit from an aggressive approach.

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The Gaboon viper ( Bitis gabonica) is an exotic snake native to sub-Saharan Africa. Gaboon viper venom is an extremely toxic hemotoxin, causing severe coagulopathy and local tissue necrosis. These are not aggressive snakes and therefore bites involving humans are rare and there is not a substantial amount of literature documenting how to manage these injuries and resultant coagulopathies. We report a 29-year-old male presenting 3 hours after a Gaboon viper envenomation resulting in coagulopathy requiring massive resuscitation and multiple doses of antivenom. The patient received various blood products based on thromboelastography (TEG) and also underwent early continuous renal replacement therapy (CRRT) to assist in correction of severe acidosis and acute renal failure. The combination of TEG to guide resuscitation, administration of antivenom, and early implementation of CRRT allowed our team to correct venom-induced consumptive coagulopathy and ultimately allow the patient to survive following this extremely deadly Gaboon viper envenomation.

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Introduction Long known to be a widespread source of injury, dog bites continue to occur and can frequently be devastating. There is lasting economic and personal hardship associated with this as many attacks can be severe, especially in children. This study describes the differences between dog bites and all other bites in the trauma patient population. Methods We included all patients from the National Trauma Data Bank (NTDB) from 2007 to 2016. All patients with an E-code for any type of bite were included. The following predictors were examined: year, age, gender, race, ethnicity, transfer, injury type, ED disposition, and ISS ≥15. Standard t-test for age, chi-squared test for all categorical variables. Wilcoxon test for non-normal quantitative variables. Statistical analyses were performed using R version 4.0.2 statistical software. “Under resourced” will be defined as Self-Pay and Medicaid. “Not known” is removed and replaced with NAs. All other insurance types are included in “Normal”. Results All variables tested as significant. All variables analyzed tested as significantly different between dog bites and other animal bites. When the group, pediatric subset, and adult subset are evaluated (Tables 1), pediatric patients are more likely to be dog bite patients if they are from an under resourced background (OR 1.3, p-value < 0.001). Distribution of bites are not significantly different from Low to Normal resource adult patients. Conclusions Dog bites continue to be a public health problem and are more likely to be severe or fatal than bites from other animals and humans. Better methods of injury prevention and education need to be established. Children from under resourced backgrounds are at an increased risk of suffering a dog bite and all physicians should screen for and educate patients and families about this risk.

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The cardiac box has been used to guide the management of trauma patients for decades. However, improper imaging can lead to erroneous assumptions about operative management in this patient population. In this study, we used a thoracic model to demonstrate imaging’s effect on chest radiography. The data demonstrate that even small changes in rotation can lead to large discrepancies in results.