agree with this. i am an adult er md but i must say i must be missing something that some of you would think of mri/mra for someone with post concussion syndrome. i may do a ct.
guide me, oh peds em gurus???
On Nov 3, 2012, at 9:09 PM, Niel Miele <[log in to unmask]> wrote:
> Assuming no papilledema, may have considered IV Reglan or Compazine push.
> Sent from my iPhone
> On Nov 3, 2012, at 11:23 PM, "Lakshmi Vemuru" <[log in to unmask]> wrote:
>> Thank you all for the responses. Answers to some of the questions that were asked:
>> is a healthy teenager, no family history of migraines, no recent
>> travel or tick bite, no rash or joint swelling, No neck pain or signs
>> of meningismus. No visual complaints except for photo sensitivity,
>> Normal fundus No imaging study was done since the time of the head injury . No history of weight loss or fatigue
>>> Date: Sat, 3 Nov 2012 16:25:54 -0400
>>> From: [log in to unmask]
>>> Subject: Teenager with two days of headache
>>> To: [log in to unmask]
>>> A 15 year old male presented with headache for 2 days with associated photophobia, nausea but no vomitings. Past
>>> history of head to head collision while playing football 6 weeks ago.
>>> no LOC, no dizziness but had mild headache. Assessed by trainer
>>> at that time and cleared. Went to PCP two days later diagnosed with possible concussion and
>>> for sports after 2 weeks. Interval history of occasional mild
>>> headaches otherwise no complaints and continued to play football. Seen
>>> by PCP day prior to our ED visit because of headache and photophobia.
>>> Diagnosed with migranes and prescribed NSAIDs. Presented to our ER
>>> because of persistent headache.
>>> Alert oriented X3 pupils equal
>>> reactive. Vitals afebrile, RR16, BP 132/68, HR 98 oxygen sat 98%.
>>> Physical exam no signs of external injuries, clear breath sounds,
>>> normal heart sounds. No orthostatic changes. No focal neurological
>>> signs but complains of dull headache and photosensitivity. Mild nausea
>>> vomiting episodes. IV fluids, toradol, and zofran given with
>>> minimal improvement. Continued to watch TV and interacting with family
>>> but requested to keep lights off. But no change in vital signs and
>>> remained stable with no cardiorespiratory distress
>>> Questions to the group:
>>> 1)With this history and physical exam how will you proceed further in this patient's management?
>>> 2) At this time would you do CT scan head or not ?
>>> 3) Any votes for MRI?
>>> 4) Admission for pain management?
>>> 5) Consult Neurologist and wait to hear from him?
>>> Lakshmi Vemuru M.D; FAAP
>>> Toledo Children's Hospital, OH
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