Case Study:
You pause outside the closed door to glance at your patient’s chart. This patient has no past medical history and is complaining of the effects of a fall. As you skim the paperwork in your hands, you are distracted by loud sobs from inside the room—cries from an individual much older than your typical pediatric patient. After gently knocking, you enter the room to find an anxious young woman with your actual patient in her arms. This new mother explains what brought her to your emergency department at 3 a.m. After finishing a middle-of-the-night nursing session with her 8-week-old son, she took him to the changing table. As she placed his soiled diaper in the garbage, the infant grew impatient, began kicking and screaming, and his changing pad—which was not secured in place—slid right off the dresser. The mother heard a “thud” as the baby’s head hit the floor after falling approximately 3 feet.
On your initial impression, the child seems to be developmentally appropriate. He is eagerly sucking away on a pacifier and appears content in his mother’s arms. A quick once-over reveals no external signs of trauma. How will you evaluate this child for injury? What are the caveats of examining a non-verbal patient? Is it necessary to obtain imaging for this baby?
Case Study Conclusion:
After taking a deep breath, you proceed with your evaluation of this patient. You systematically address the ABC’s, working your way through the primary and secondary survey. You calculate the Modified Pediatric Glasgow Coma Scale, arriving at a score of 15. You conduct a thorough history and examination, finding no neurological abnormalities. You feel that this patient has no indications for any imaging studies. You explain to the mother that most pediatric head injuries do not result in significant intracranial pathology, and she expresses relief and gratitude.
You explain that the patient will require close follow-up, and the mother informs you that the baby already has a routine 2-month well-child check scheduled for later in the week. After going over discharge instructions with the infant’s mother and outlining signs and symptoms that might warrant concern, you take advantage of this opportunity to discuss with the patient’s mother how this incident might have been prevented. In addition, you review a number of principles of infant home safety with her, and she seems to take your recommendations with appreciation.
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