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Thanks everyone for the input
We did not give hypertonic saline
The child was loaded with phenytoin
No seizures afterward 
CT showed no bleeding
Taken by the neurosurgeons to the OR
Extubated the next morning
Awake with no focal neurological deficits
 

-----Original Message-----
From: Prof. Paret Gidi [mailto:[log in to unmask]] 
Sent: Wednesday, August 09, 2017 6:44 AM
To: קוצר ערן פרופ'; [log in to unmask]
Subject: RE: Would you treat with hypertonic saline?

YES INDEED
WHAT WAS THE NA

Prof  G. Paret, M,D, MHA
Director,  Dept of Pediatric Intensive Care Safra Children's Hospital, The Sheba Medical Ctr.
Chairman, The Scientific Council,
Israel Medical Association
Israel
Email: [log in to unmask]
Tel:972-52-6667310

-----Original Message-----
From: Pediatric Emergency Medicine Discussion List [mailto:[log in to unmask]] On Behalf Of Eran Kozer
Sent: Tuesday, August 08, 2017 10:50 AM
To: [log in to unmask]
Subject: Would you treat with hypertonic saline?

 A question for the group:
A 15 y old boy arrived to the ED 20 minutes after falling from a ladder (approximately 2m height). There was no LOC. On arrival to the ED – GCS 15, normal vitals, no focal neurological signs (walking,  talking with the nurse). Large open depressed temporal skull fracture.  5 minutes after arrival – seizures, treated with midazolam, the seizures stopped, intubated (RSI).  HR 110, BP 130/80 pupils equal and reactive. 
Would you treat with hypertonic saline/mannitol at this point?  (CT is immediately available for this patient) Thanks Eran

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