Kid fell off bike: what would you anticipate?

[MikeyBSN]

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

[MassED, BSN, RN]

I'd say #3. We would do Xrays if the kid was c/o pain in the legs or arms. Probably do a CT of the head just to cover our a$$es. Maybe a line depending on the doc. It is all about covering the behind. If this were my kid I probably wouldn't have even presented to the ED.

Pediatricians in the ER are much more conservative for ordering CT's on children, as opposed to adults w/ the same complaint. We'll see in 20 or so years the outcome of so much radiation we blast our ER patients with.....

[Guest219794]

It depends on who's kid it is. If, for example, a friend of the doc brought his kid in, it would most likely be what is in the best interest of the kid, option 1. If not, it depends on the doc. some will do the right thing, some won't. Nobody is getting sued over an adverse outcome from a ct.

My brother in law is a radiologist. If somebody scanned one of his kids for this, I can only imagine the hell he would raise.

I just nearly did conscious sedation on a 2 year old who's parent's reported a fully resolved short incident of ataxia and acting differently. The fact that the kid pulled his IV while he was climbing the beds and pulling stuff out of the cabinets slowed the process enough for the mother to finally refuse. In the mean time, the doc did a peds consult who reccomend against the scan, bases on risk/benefit.

[nolabarkeep]

Seasoned ER doctor: Option 1.

New ER doctor: CYA protocol.

It's amazing how much money and resources are wasted just to avoid that one in a million missed diagnosis. I've seen people have the super deluxe work-up only to request a specific amount of days off of work once they get the negative results.

[nuangel1, BSN, RN]

depends on the dr in my ed .i have seen number 1 .i have also seen number 2 neuro exam observe and ct .no iv unless its needed.

[rbyrdrn]

Ok, trying not to read too much into the question....and going c the information available....my answer is 1. Of course I would like to change my answer if s/s change.

[honey2000]

I don't think there has to be LOC to diagnose a concussion. I've taken care of plenty of people who weren't KO'd that were obviously suffering from a concussion. I pick option 1. How he is currently acting and looking is an indicator. Neuro exam, Observation, strict head injury instrucions and information about what to look for to his parents, must be woken up every 2 hrs during the night. Some might do a head CT, but he presents as alert, oriented and walking/talking. Not repeating himself,