This is a difficult case as children at 12 years of
age have tremendous reserve capacity and are often
stoic. Many times the history is inaccurate. One
therfore cannot be too cautious.
Having said that one has to admit that since you pose
this question to the group this did not turn out to be
an ordinary laceration thus making the group conjure
up unlikely and remote scenarios, which would be all
to easy to miss even by the most astute clinician,
especially our IM, surgical and specialist
counterparts. These specialists fail to recognise that
often the best diagnostic tool and even therapy is
time and that they have time on their side unlike ER
physicians who have to make a call without having the
luxury of time to keep up the throughput in a busy
emergency room. Any staff physician who is in doubt
will admit while the Emergency room physician is
usually given a hard time for making a similar call,
i.e "If in doubt admit"
Having made much noise about the state of affairs, can
I suggest a solution? There is no ideal solution as we
do not live in an ideal world and are engulfed by
tempatation to get ahead of the pack making us
vulnerable to the design of regulators, administrators
and businessmen including corporations. But I do have
some suggestions that I would be happy to post if any
one is interested.
To get back to the case, under ordinary circumstances
I would have done the following:
1. Suture laceration.
2. Consider urethral rupture.
3. Consider blunt abdominal trauma and perform a a CT
w and w/o.
4. Admission and close observation with q2-3 neuro
checks x 24 hours.
--- "ashes.mukherjee" <[log in to unmask]>
> A question,
> I had a 12 yr Boy hit by a car at approximately
> 15mph over his left leg head hitting the windscreen.
> Temporary loss of consciousness at site seen by
> off-duty paramedic. Brought into the emergency dept
> on a spinal board hemodynamically stable RR-2o,
> PERL, 2" lacn over lt eyebrow with no evidence of #
> GCS - E2-3M6V2 with no other obvious injuries. Was
> varying from being agitated to calm. His CXR was
> normal and his pelvic X-ray showed a fracture of his
> Rt suprapubic ramus. Abdomen was soft and nontender.
> He was intubated for CT scan and the scan was
> normal. What would the general opinion be of the
> next step of management.
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