This was an interesting :
for the first time in the my experience with the list, facing a problem while working I was able to generate opinions and help in real time, while the patient was in the E.D.
I thanks all who quickly reponded...you should know that I, the residents and the students looked at the opinions expressed, and other in-house sources to reviewed the issue of managing minor head trauma with a small hematoma in an infant. We then proceeded to conclude the care for this patient.
Unfortunatel I did not emphasize the main issue I had , does a breast feeding mother on aspirin (she was on Lovenox until recenly) increase the risk for her infant who sustained minor head trauma in the same way elderly patients on coumadin are at higher risk for inctracranial bleed after relatively mild head trauma.
In the end I decided NOT to image the child, she was just too playfull and charming and I elected instead to observe her for many hours in the E.D. (the old way...) and in the end she went home, my follow-up call just now..."child is fine".
While I may miss a small bleed, it is very unlikely that I missed an operable bleed.
In the end, with reliable parents, a working phone and a good PMD I thought that the risk of imagng outwighed the risk of bleed...my call
Based on my reading, and my experience, I have yet to see a FOREHEAD head trauma from a minor (under 4 feet ) fall resulting in a skull fracture or an operable bleed... parietal or even occipital trauma-->yes, but fromtal trauma -->no
Thanks again to all for a live on line help!
Giora (Gill) Winnik MD
Maimonides Medical Center
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