Blast injuries in children: a mixed-methods narrative review

Abstract

Background and significanceBlast injuries arising from high explosive weaponry is common in conflict areas. While blast injury characteristics are well recognised in the adults, there is a lack of consensus as to whether these characteristics translate to the paediatric population. Understanding blast injury patterns in this cohort is essential for providing appropriate provision of services and care for this vulnerable cohort.MethodsIn this mixed-methods review, original papers were screened for data pertaining to paediatric injuries following blasts. Information on demographics, morbidity and mortality, and service requirements were evaluated. The papers were written and published in English from a range of international specialists in the field.ResultsChildren affected by blast injuries are predominantly male and their injuries arise from explosive remnants of war, particularly unexploded ordinance. Blasts show increased morbidity and mortality in younger children, while older children have injury patterns similar to adults. Head and burn injuries represent a significant cause of mortality in young children, while lower limb morbidity is reduced compared with adults. Children have a disproportionate requirement for both operative and non-operative service resources, and provisions for this burden are essential.ConclusionsCertain characteristics of paediatric injuries arising from blasts are distinct from that of the adult cohort, while the intensive demands on services highlight the importance of understanding the diverse injury patterns in order to optimise future service provisions in caring for this child blast survivor.

Damage control approach and reduced resuscitation of the polytraumatized pediatric patient in the emergency room

“…Se debe valorar la posibilidad de aplicar protocolos de transfusión masiva balanceada con la clasificación ABC de transfusión masiva. Si aparecen signos de shock administrar líquidos para mejorar la hemodinámia (19) . Se debe manejar reposición de líquidos restrictiva, es decir de no contar con sangre utilizar como segunda opción solución salina hipertónica al 3% a una dosis de 5-10 cc kg en 20 minutos para evitar el fenómeno de reperfusión y la inestabilidad de los coágulos ya formados (Fenómeno" popping the Clot"), tres dosis, de no poder aplicar esta opción utilizar solución salina al 0,9% a la dosis de 20 cc kg durante 20 minutos (20) .…”

“…• Evaluación de las pupilas mediante la respuesta de la pupila a la luz (tamaño, capacidad de respuesta y simetría), es un indicador de la función troncoencefálica. -La escala de respuesta pediátrica AVDI (alerta, verbal, dolor, inconsciente) (21,22) permite evaluar la función de la corteza cerebral y por último -La escala de Glasgow (apertura ocular, respuesta verbal y respuesta motora).determina el nivel de conciencia y el estado neurólogo del paciente pediátrico.…”

“…Entonces, el consentimiento informado es básicamente un proceso de comunicación y tiene que enfocarse en tranquilizar al paciente, a beneficiarlo y a enfrentar de mejor manera su enfermedad (18,19) .…”

Arms sales and child health

“…Some of the devastating impacts are illustrated in table 1. [5][6][7][8][9][10][11][12][13][14][15][16] The table is not a comprehensive review of the effects of armed conflict, as recent systematic reviews have documented this. 1 4 It simply illustrates the devastating effect of armed conflict on child health.…”

“…Landmines and cluster munitions are a particular problem in certain regions, causing untold immediate and long-term suffering. 6 An additional problem is the widespread availability of firearms of a variety of types. 17 The aim of this narrative review is to explore the effects of the arms trade on child health.…”