311) A 3 year old male child is brought to the emergency room by his mother after he fell from his tricycle and sustained an injury to his head . The child was found to be alert and awake after the fall, however, he reported mild pain on the right side of his head. His mother noted a small bruise and swelling over the right side of his scalp. There is no history of vomiting or nausea. He has no past history of convulsions or epilepsy. Family history is unremarkable. At this time, child is quiet and reports mild headache. On examination, he is alert and awake. He is not in distress. There is small contusion on the fronto-parietal aspect of his scalp. There is no evidence of hematoma. Palpation does not reveal any depressed fracture. Neurological examination is normal with out any deficits. Rest of the physical exam is normal. Which of the following is the most appropriate management at this time?
A) Contact Child Protection Services
B) Perform Head CT scan
C) Admit to Hospital
D) Observe at home
E) Skull X-rays
Filed under: Uncategorized, USMLE Test Prep | Tagged: archer neurology, archer pediatrics, emergency medicine archer, neurology usmle mcqs, usmle step 3 emergency medicine, usmle step 3 neurology, USMLE STEP3 PEDIATRICS |
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Observe at home, no loc, pe neg, clinic ok.
D.
E
this patient needs a skull x ray along with a period of observation…as the patient may be in lucid interval for extradural hematoma……….if any of the danger signs appear like vomiting, deteriorating GCS, convulsions, persistant headache, then go for CT scan
observe at home..
d
observe at home
take head ct scan
b
d
aaa
D…..
CT Scan in Head Injuries[4][5]
Selection of adults for CT Scan
Urgent scan if any of the following (results within 1 hour):
Glasgow Coma Scale (GCS) <13 when first assessed or GCS 1 episode of vomiting (SIGN guidance suggests 2 distinct episodes of vomiting)
Coagulopathy + any amnesia or loss of consciousness since injury
A CT scan is also recommended (within 8 hours of injury) if there is either:
More than 30 minutes of amnesia of events before impact
Or any amnesia or loss of consciousness since injury if:
Aged ≥65 years
Coagulopathy or on warfarin
Dangerous mechanism of injury
Road traffic accident (RTA) as a pedestrian
RTA – ejected from car
Fall >1 m or >5 stairs.
Selection of children (under 16 years) for CT Scan
Urgent scan if any of the following:
Witnessed loss of consciousness >5 minutes
Amnesia (antegrade or retrograde) >5 minutes
Abnormal drowsiness
≥3 Discrete episodes of vomiting
Clinical suspicion of nonaccidental injury
Post-traumatic seizure (no PMH of epilepsy)
GCS <14 in emergency room
(Paediatric GCS <15 if aged <1)
Suspected open or depressed skull fracture or tense fontanelle
Signs of base of skull fracture*
Focal neurological deficit
Aged 5 cm
Dangerous mechanism of injury (high-speed RTA, fall from >3 m, high-speed projectile)
*Signs of basal skull fracture: haemotympanum, ‘panda’ eyes (bruising around the eyes), cerebrospinal fluid (CSF) leakage (ears or nose) or Battle’s sign (bruising which sometimes occurs behind the ear in cases of basal skull fracture).