What do you think is the proper course of action for the following scenario:
A 7 year old was on the bike with his brother and they both fell off. His older brother had abrasions to both legs. The 7 year old had an abrasion to the the hand and occipital area of the head. There was no bleeding and no hematoma. The kid ambulated into the ED. He was awake, alert and acting appropriately as per the father. There was no loss of consciousness. No nausea, no vomiting, his gait was steady and his pupils were PERRLA. What do you think the treatment should be?
Many studies suggest the increase in thyroid cancer could be partly due to pediatricians’ increased use of CT-scans. If it were my asymptomatic kid, theres no way in heck I'd let them CT him.
I work in the ED and I do agree it's up to the doc really. We have docs that would just do the basics and docs that will give them an entire work up "just in case". I will venture to say that the answer is a combination of option 1 and option 2. The docs will want an x-ray to r/o any possible fracture, then observe him for a few hours then send him home if all seems fine with his neuro. assessment. But there are a lot of times, the docs order a head CT to be on the safe side, since it shows soft tissue, so option is a possibility though we wouldn't start an IV until we knew it was necessary.
At the ED where I work it would depend on which doctor is working. The majority are major CYA docs and would do a combination of #1 and #3 - neuro exam, IV, head CT, observation, and discharge with verbal and written instructions. But there are a few who would opt for just #1.
Well, I think number one is clearly the correct answer, although I think some docs might opt for number 2. Head CTs cause 3000 X the amount of radiation as an x-ray and have been shown to greatly increase cancer in children. The kid had a very unimpressive story. However, this was an actual case I had. I was working with a great pediatric ED doctor who was also a peds intensivist. The kid showed up with the above story. After some observation the doc was literally walking over to get discharge instructions when the kid vomited on the floor. So he said, "Okay we should probably do the CT now." Can you believe this kid had a skull fracture and a bleed! I could not believe it, like another nurse said, I probably would not have even taken my kid to the ED for this (until he vomited). The bleed was small, but still, I've never seen one with such an unimpressive story and clinical findings.
Well, I think number one is clearly the correct answer, although I think some docs might opt for number 2. Head CTs cause 3000 X the amount of radiation as an x-ray and have been shown to greatly increase cancer in children. The kid had a very unimpressive story. However, this was an actual case I had. I was working with a great pediatric ED doctor who was also a peds intensivist. The kid showed up with the above story. After some observation the doc was literally walking over to get discharge instructions when the kid vomited on the floor. So he said, "Okay we should probably do the CT now." Can you believe this kid had a skull fracture and a bleed! I could not believe it, like another nurse said, I probably would not have even taken my kid to the ED for this (until he vomited). The bleed was small, but still, I've never seen one with such an unimpressive story and clinical findings.
I work on a traum unit - we get the pts from ER that don't go to ICU. I do work with adults, however this is how we would probably treat the boy.
*inpt for observation
*CT of head - just because things look normal, don't mean that they are
What do you think is the proper course of action for the following scenario:
A 7 year old was on the bike with his brother and they both fell off. His older brother had abrasions to both legs. The 7 year old had an abrasion to the the hand and occipital area of the head. There was no bleeding and no hematoma. The kid ambulated into the ED. He was awake, alert and acting appropriately as per the father. There was no loss of consciousness. No nausea, no vomiting, his gait was steady and his pupils were PERRLA. What do you think the treatment should be?
1) Neuro exam, observation and discharge
2) Neuro exam and head x-ray
3) Neuro exam, IV and Head CT
4) Trauma Code
without reading others' responses before posting, #1 is how we do it where I work.
chelynn
131 Posts
I would go with answer number 1 also. It's the least evasive tx and most appropriate for information given.