Do we need to perform a digital rectal exam in injured children?
Do injured children need a digital rectal exam? Read on to learn about the evidence behind what is often a stressful and traumatic exam technique for children.
Is parental report of “child acting abnormally” as the only symptom worrisome for TBI?
Children with closed head injury who are reported as acting abnormally by their guardian, with no other concerning findings are low risk for clinically important TBI.
Clinical predictors and evaluation of blunt abdominal trauma in children
This post details clinical predictors associated with intraabdominal injury as well as a suggested evaluation pathway for children with blunt abdominal trauma.
“Dry drowning” the summer medical oxymoron
Undoubtedly you will see a child with a "near drowning" if you work in the ED during the summer. Most children are fine, even those that received some back blows, mouth to mouth or some semblance of bystander rescue maneuvers. Asymptomatic children (no respiratory symptoms) can be safely discharged home. Those that are having difficulty breathing or other symptoms should [...]
To scan or not to scan – Part two: Answers and a summary of literature
If you recall from my previous post we were considering when to get a head CT on a pediatric patient with a closed head injury, and specifically how to approach this with the family. In general I find that its best to be honest and discuss the criteria outlined in the Kuppermann article (you know the one). It investigated risk of [...]
To scan or not to scan – Three scenarios to ponder
I ended up seeing three patients, all of whom presented by smacking their heads on hard surfaces. I've changed their names and ages to protect the innocent, and to avoid the wrath of Hungry Hungry HIPAA. 10 year old after a bike accident The first patient was a school aged male whose bike failed him, and whose helmet was hanging [...]
FYI on ABI
In adults calculating the ankle-brachial index (ABI) is a relatively simple way to confirm the clinical suspicion of lower extremity arterial occlusive disease. In pediatric lower extremity limb injury patients where vascular compromise is a concern (think bad fractures, lawnmower calamities) it may also be a helpful test. Technique Measure the systolic blood pressure at the ankle Place a blood pressure cuff [...]
Briefs: Assessing and staging burn severity
It's cold out and people are trying to warm themselves up by any means necessary. In the Emergency Department that means you may end up seeing some burns. It is important not only to assess these burns, but also determine what percentage of the body surface area is superficial versus partial AND full thickness. Wait a second... Aren't we supposed [...]
Isolated loss of consciousness and risk for clinically important traumatic brain injury
Continuing onward with the top ten articles presented at the recent AAP NCE in San Diego is yet another secondary analysis of the original PECARN study on clinically important TBI (ciTBI). This time looking at children with isolated loss of consciousness (LOC). The outcomes were ciTBI which resulted in death, neurosurgery, intubation for >24 hours, or hospitalization for ≥2 nights and a comparison [...]
Minor TBI and vomiting alone? Should we be worried?
Next up from the top ten articles presented at the recent AAP NCE in San Diego is a secondary analysis from the PECARN head injury study published in Lancet in 2009. I'm sure that most have you have seen a child who hit their head with vomiting as their only symptom. The authors compared children with isolated vomiting versus those with vomiting [...]
