{"id":6902,"date":"2025-02-16T21:42:47","date_gmt":"2025-02-16T21:42:47","guid":{"rendered":"https:\/\/paeder.com\/24-12-traumatologic-emergencies"},"modified":"2025-02-16T21:42:54","modified_gmt":"2025-02-16T21:42:54","slug":"24-12-traumatologic-emergencies","status":"publish","type":"post","link":"https:\/\/paeder.com\/en\/24-12-traumatologic-emergencies","title":{"rendered":"24-12 Traumatologic emergencies"},"content":{"rendered":"<div class='flex_column av-26pfrx-ab5a0b559933313b7bc04d9911674566 av_one_fifth  avia-builder-el-0  el_before_av_three_fifth  avia-builder-el-first  first flex_column_div '     ><\/div>\n<div class='flex_column av-ldqu71-74ec219edcb9e7038563aa9b47a45d75 av_three_fifth  avia-builder-el-1  el_after_av_one_fifth  el_before_av_one_fifth  flex_column_div '     ><p>\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-m785iwye-0a86caba0c1eaea9823e749cc6854036\">\n.avia-image-container.av-m785iwye-0a86caba0c1eaea9823e749cc6854036 img.avia_image{\nbox-shadow:none;\n}\n.avia-image-container.av-m785iwye-0a86caba0c1eaea9823e749cc6854036 .av-image-caption-overlay-center{\ncolor:#ffffff;\n}\n<\/style>\n<div  class='avia-image-container av-m785iwye-0a86caba0c1eaea9823e749cc6854036 av-styling- avia-align-center  avia-builder-el-2  el_before_av_hr  avia-builder-el-first '   itemprop=\"image\" itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/ImageObject\" ><div class=\"avia-image-container-inner\"><div class=\"avia-image-overlay-wrap\"><img decoding=\"async\" class='wp-image-6895 avia-img-lazy-loading-not-6895 avia_image ' src=\"https:\/\/paeder.com\/wp-content\/uploads\/2025\/02\/Header-Fremdkoerperingestion-1920x761-1.jpg\" alt='' title='Header Fremdkoerperingestion 1920x761'  height=\"761\" width=\"1920\"  itemprop=\"thumbnailUrl\" srcset=\"https:\/\/paeder.com\/wp-content\/uploads\/2025\/02\/Header-Fremdkoerperingestion-1920x761-1.jpg 1920w, 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data-created_by=\"avia_inline_auto\" id=\"style-css-av-iupnst-9319027209a7d9ab8c485dd728cbb12a\">\n#top .hr.hr-invisible.av-iupnst-9319027209a7d9ab8c485dd728cbb12a{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-iupnst-9319027209a7d9ab8c485dd728cbb12a hr-invisible  avia-builder-el-3  el_after_av_image  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div><br \/>\n<section  class='av_textblock_section av-m785jgau-9f429c52ed3c240e03c90594855f3719'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p style=\"text-align: right;\">February 16, 2025<\/p>\n<\/div><\/section><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-m785jzot-44c910a64dab059cf493cfacb8b068e4\">\n#top .av-special-heading.av-m785jzot-44c910a64dab059cf493cfacb8b068e4{\npadding-bottom:10px;\ncolor:#fc0001;\n}\nbody .av-special-heading.av-m785jzot-44c910a64dab059cf493cfacb8b068e4 .av-special-heading-tag .heading-char{\nfont-size:25px;\n}\n.av-special-heading.av-m785jzot-44c910a64dab059cf493cfacb8b068e4 .special-heading-inner-border{\nborder-color:#fc0001;\n}\n.av-special-heading.av-m785jzot-44c910a64dab059cf493cfacb8b068e4 .av-subheading{\nfont-size:15px;\n}\n<\/style>\n<div  class='av-special-heading av-m785jzot-44c910a64dab059cf493cfacb8b068e4 av-special-heading-h2 custom-color-heading  avia-builder-el-5  el_after_av_textblock  el_before_av_hr '><h2 class='av-special-heading-tag'  itemprop=\"headline\"  >Foreign body ingestion: the most important rules of the new S2K guideline<\/h2><div class=\"special-heading-border\"><div class=\"special-heading-inner-border\"><\/div><\/div><\/div><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-hwh0st-4c016aa3b0547c6cd8f85bf8c7f585d1\">\n#top .hr.hr-invisible.av-hwh0st-4c016aa3b0547c6cd8f85bf8c7f585d1{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-hwh0st-4c016aa3b0547c6cd8f85bf8c7f585d1 hr-invisible  avia-builder-el-6  el_after_av_heading  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div><br \/>\n<section  class='av_textblock_section av-g5rv31-a8ba5b3568d8777bd535a38d3277454c'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p class=\"EndNoteBibliography\"><span style=\"color: #333333;\"><strong>Lidocaine has also gained some popularity as an analgesic in pediatric medicine, although there is no scientific basis for this. At the outset, a very important observation: the therapeutic range of lidocaine is very narrow.<\/strong><\/span><\/p>\n<h3><span style=\"color: #333333;\"><strong>Misinformation through video<br \/>\n<\/strong><\/span><\/h3>\n<p class=\"EndNoteBibliography\"><span style=\"color: #333333;\">While therapeutic plasma concentrations are 2.5-3.5 mcg\/ml, toxicity must be expected at 5 mcg\/ml [1]. This means that with this drug in particular, dosing errors are very dangerous. As in the fatal case of a seven-month-old infant who was given lidocaine in an intraosseous needle<a style=\"color: #333333;\" href=\"https:\/\/www.focus.de\/regional\/hamburg\/staatsanwaltschaft-ermittelt-sieben-monate-altes-kind-starb-bei-rettungseinsatz-eltern-zeigen-den-behandelnden-notarzt-an_id_24285671.html\" target=\"_blank\" rel=\"noopener\">(go here to Focus article<\/a>).<\/span><\/p>\n<p class=\"EndNoteBibliography\"><span style=\"color: #333333;\">It is particularly tragic that the desired analgesia for drug administration via an intraosseous needle cannot be achieved with it, as clinical everyday life in the children&#8217;s hospital shows. The reason for the popularity of this practice was probably a video published by the &#8220;New England Journal of Medicine&#8221; in 2011 [2]. Even in the same issue of NEJM [3], it was pointed out that there was no evidence for the efficacy described here.<\/span><\/p>\n<p class=\"EndNoteBibliography\"><span style=\"color: #333333;\">Nevertheless, the European Resucitation Council guidelines [4] and a German S1 guideline recommend analgesia with lidocaine for intraosseous needles [5]. Both also offer no evidence of efficacy, which remains absent to this day. This is also stated by the Drug Commission of the German Medical Association (Akd\u00c4), which literally writes the following in the German Medical Journal (and thus has a duty of care for the German medical profession!) [6]: <i>&#8220;In the opinion of the Akd\u00c4, the concept of intraosseous pretreatment with lidocaine to avoid pain before intraosseous administration of drugs and volume replacement in pediatric patients should be rejected, as the active substance can be dangerous due to its unpredictable systemic effect. There are also alternatives to pain therapy with opioids such as morphine or fentanyl.&#8221;<\/i> It is to be hoped that the guidelines mentioned will receive an erratum and be corrected as quickly as possible!<\/span><\/p>\n<h3 class=\"EndNoteBibliography\"><span style=\"color: #333333;\"><strong>Ineffective and potentially life-threatening!<\/strong><\/span><\/h3>\n<p class=\"EndNoteBibliography\"><span style=\"color: #333333;\">It has also not been shown to be effective as a systemic analgesic when administered intravenously &#8211; again, there are safety concerns [1,7]. The only indication for lidocaine in pediatric emergency medicine is for severe ventricular arrhythmias with i.v. administration of 1 mg\/kg bw as an alternative to amiodarone &#8220;if the user is experienced in its use&#8221; [4].<\/span><\/p>\n<p class=\"EndNoteBibliography\"><span style=\"color: #333333;\">Therefore, the Pediatric Emergency Use Guide (P\u00e4dNFL) only specifies this exact use for lidocaine. Safety is often also knowing what NOT to do!<\/span><\/p>\n<\/div><\/section><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-dizval-4c6e005447f453ec3302d0e4793fc233\">\n#top .hr.hr-invisible.av-dizval-4c6e005447f453ec3302d0e4793fc233{\nheight:40px;\n}\n<\/style>\n<div  class='hr av-dizval-4c6e005447f453ec3302d0e4793fc233 hr-invisible  avia-builder-el-8  el_after_av_textblock  el_before_av_button '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div><br \/>\n<div  class='avia-button-wrap av-bztey5-b41e9823ba3351cc04e66bca68325c77-wrap avia-button-center  avia-builder-el-9  el_after_av_hr  el_before_av_hr ' >\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-bztey5-b41e9823ba3351cc04e66bca68325c77\">\n#top #wrap_all .avia-button.av-bztey5-b41e9823ba3351cc04e66bca68325c77{\nfont-size:20px;\nbackground-color:#ffcd00;\nborder-color:#ffcd00;\ncolor:#444444;\n-webkit-transition:all 0.4s ease-in-out;\n-moz-transition:all 0.4s ease-in-out;\n-ms-transition:all 0.4s ease-in-out;\n-o-transition:all 0.4s ease-in-out;\ntransition:all 0.4s ease-in-out;\n}\n<\/style>\n<a href='https:\/\/paeder.com\/shop'  class='avia-button av-bztey5-b41e9823ba3351cc04e66bca68325c77 avia-icon_select-yes-left-icon avia-size-large avia-position-center' ><span class='avia_button_icon avia_button_icon_left' aria-hidden='true' data-av_icon='\ue859' data-av_iconfont='entypo-fontello'><\/span><span class='avia_iconbox_title' >Order the P\u00e4dNFL\/P\u00e4dOP here<\/span><\/a><\/div><br \/>\n\n<style type=\"text\/css\" data-created_by=\"avia_inline_auto\" id=\"style-css-av-b6aj25-d028dfc0d6816b5cfeb7fb1447824794\">\n#top .hr.hr-invisible.av-b6aj25-d028dfc0d6816b5cfeb7fb1447824794{\nheight:20px;\n}\n<\/style>\n<div  class='hr av-b6aj25-d028dfc0d6816b5cfeb7fb1447824794 hr-invisible  avia-builder-el-10  el_after_av_button  el_before_av_textblock '><span class='hr-inner '><span class=\"hr-inner-style\"><\/span><\/span><\/div><br \/>\n<section  class='av_textblock_section av-8u2rjh-7d54c89c3a2336dc2ffa7a7230be687e'  itemscope=\"itemscope\" itemtype=\"https:\/\/schema.org\/BlogPosting\" itemprop=\"blogPost\" ><div class='avia_textblock'  itemprop=\"text\" ><p class=\"EndNoteBibliography\"><strong>Literature:<\/strong><\/p>\n<ol>\n<li class=\"EndNoteBibliography\"><span lang=\"EN-US\">Hall EA, Sauer HE, Davis MS et al. Lidocaine Infusions for Pain Management in Pediatrics. Paediatric drugs 2021; 23: 349-359, DOI: 10.1007\/s40272-021-00454-2.<\/span><\/li>\n<li class=\"EndNoteBibliography\"><span lang=\"EN-US\">Nagler J, Krauss B. Intraosseous Catheter Placement in Children. New England Journal of Medicine 2011; 364: e14, DOI: 10.1056\/NEJMvcm0900916.<\/span><\/li>\n<li class=\"EndNoteBibliography\"><span lang=\"EN-US\">Thim T, Lofgren B, Grove EL. Intraosseous catheter placement in children. N Engl J Med 2011; 364: 2171; author reply 2171, DOI: 10.1056\/NEJMc1103310#SA1.<\/span><\/li>\n<li class=\"EndNoteBibliography\"><span lang=\"EN-US\">Van de Voorde P, Turner NM, Djakow J et al. European Resuscitation Council Guidelines 2021: Paediatric Life Support. Resuscitation 2021; 161: 327-387, DOI: 10.1016\/j.resuscitation.2021.02.015.<\/span><\/li>\n<li class=\"EndNoteBibliography\"><span lang=\"EN-US\">Helm M, Bernhard M, B\u00f6ttiger BW et al. S1 Guideline: The intraosseous infusion in emergency medicine. Anaesthesiol Intensivmed 2018; 59: 667-677,  <\/span><\/li>\n<li class=\"EndNoteBibliography\"><span lang=\"EN-US\">Akd\u00c4. &#8220;From the UAW Database&#8221; Intraosseous administration of lidocaine for pain management in pediatric patients &#8211; an inappropriate, potentially dangerous off-label recommendation. Deutsches Aerzteblatt 2022; 119: A2157-A2158,<\/span><\/li>\n<li class=\"EndNoteBibliography\"><span lang=\"EN-US\">Heath C, Hii J, Thalayasingam P et al. Perioperative intravenous lidocaine use in children. Paediatr Anaesth 2022, DOI: 10.1111\/pan.14608.<\/span><\/li>\n<\/ol>\n<\/div><\/section><br \/>\n<div  class='av-social-sharing-box av-7cle9p-f38b086984f430c738647853bbbf6193 av-social-sharing-box-default  avia-builder-el-12  el_after_av_textblock  el_before_av_hr  av-social-sharing-box-fullwidth'><div class=\"av-share-box\"><h5 class='av-share-link-description av-no-toc '>Share post<\/h5><ul class=\"av-share-box-list noLightbox\"><li class='av-share-link av-social-link-facebook' ><a target=\"_blank\" aria-label=\"Share on Facebook\" href='https:\/\/www.facebook.com\/sharer.php?u=https:\/\/paeder.com\/en\/24-12-traumatologic-emergencies&#038;t=24-12%20Traumatologic%20emergencies' aria-hidden='false' data-av_icon='\ue8f3' data-av_iconfont='entypo-fontello' title='' data-avia-related-tooltip='Share on Facebook' rel=\"noopener\"><span class='avia_hidden_link_text'>Share on Facebook<\/span><\/a><\/li><li class='av-share-link av-social-link-twitter' ><a target=\"_blank\" aria-label=\"Share 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