1. “I didn’t think I had to evaluate for intraabdominal organ injury after the child fell off the bicycle handle.” Children have intra-abdominal organs that are proportionally larger and not well protected by their weaker abdominal musculature and cartilaginous ribs. Therefore, minor traumatic forces can easily cause injury to these intra-abdominal organs.
2. “I didn’t get a lumbar x-ray of that child involved in a car accident who was restrained in a lap-belt.” Children in motor vehicle accidents who wear a lap-only seat belt are prone to intra-abdominal solid organ, hollow viscous, and lumbar spine injuries. Due to their underdeveloped pelvis, the seat belt rides higher on the abdomen and rapid deceleration causes the child to sustain a hyperflexion injury of the upper lumbar spine and compression of the abdominal organs between the seat belt and the spine.
3. “I didn’t suspect that child would go into shock from her inflicted abdominal injuries.” Children who sustain intra-abdominal injuries from abuse are usually younger. The injuries are usually severe and because the history is inadequate and the time to presentation is usually delayed, these children frequently present in shock.
4. “The emergency medical technician told me the child had a PTS score of 4, and I told him it was okay to bring the child to my level 3 hospital.” A PTS score less than 8 is the recommended threshold for diverting children to a designated trauma center. Children with a PTS score greater than 8 have virtually no mortality. Significantly injured children have a better outcome in a dedicated trauma center.
5. “I didn’t think the child was in shock since his blood pressure was normal.” The heart rate is the most sensitive indicator of intravascular volume status in infants and young children. Hypovolemic shock is heralded by tachycardia long before hypotension becomes apparent.
Purchase this issue for the other 5 Risk Management Pitfalls
