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Minor trauma in children, a pocket guide
  1. S Fountain-Polly

    Statistics from

    Edited by Ffion Davies. London: Hodder Murray, 2004, £19.99, pp 210. ISBN 0340732040

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    For many paediatric doctors the emergency department (aka A&E) is only visited when referrals are made, or the crash bleep summons with its screeching siren. These visits are usually straightforward, especially if the APLS creed can be chanted. However, for those of us who missed the emergency department in a rotation, the intricate management of minor cuts and bruises may evade us. Davies’s guide to minor trauma will help to glue the gaps in knowledge. From the initial child’s drawing on the front cover, there are a number of helpful illustrations, photographs, and x ray pictures that aid the guide and its reader. The presentation of the text leads your eyes through the various subheadings; important ideas are highlighted with the use of miniature road signs that are supposed to elicit an emergency stop.

    The first few chapters set minor trauma in its context and deal with the basics of management. Despite recent opposition to the use of such terminology, the reader is offered several interesting statistics on accidents and the outline of how strategies in society can prevent them. Pain assessment and management is given its rightfully prominent position as the foundation for good holistic care of the child. An overview of general wound and soft tissue management follows before the guide leads the reader through chapters exploring various locations of the body. Each chapter carries a concise description of the various minor injuries that can affect the area, accompanied by useful x ray pictures; ploughing through lengthy radiology and orthopaedic texts may now be circumvented.

    More specific injuries such as minor burns are covered before reaching chapters that explore the difficulties of frontline medicine that have recently been exposed by the continued media interest in child protection. The chapter on non-accidental injury is regularly signposted with danger points. Davies makes one profound observation that will resonate with many doctors, “You could be forgiven for thinking that paediatricians are perhaps obsessed by the subject but the reality is that delay in diagnosis is still common, the diagnosis itself can be extremely difficult to make, and the repercussions of either a ‘false negative’ or ‘false positive’ can be very damaging.” The following chapter helps explain the forensic and medicolegal aspects of assessing children with suspicious injuries, or those that might require personal presence in a court of law.

    The final chapter looks at practical procedures. Most of us know how to negotiate the examination of the ear, nose, and throat, but how do you tie a sling? If your first aid is a little rusty, then here is your answer. The mystery of gluing wounds is revealed. A small section on trephining the nail for subungal haematomas is found; and if your department does not have the specific tool for the job then the guide provides a “Blue Peter” solution with a paperclip and sticky-backed plasters. Overall the guide is a useful, concise aid to managing minor trauma, and would be a valuable reference for any emergency department. It collects together wisdom on the assessment and management of problems not easy to obtain elsewhere; apart from the experienced casualty nurse.

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