babli
Forum Guru
Topics: 40
Posts: 425
|
a mother brings in her 8 month old infant for trouble breathing.she says infant has not had a fever but seems sleepy.exam reveals a lethargic,apathetic infant with respiratory rate of 30/min.b/l retinal haem & a full anterior frontanelle are noted on exam.infant has no evidence of bruises.ct shows subdural hematoma.which of the following is least appropriate?
a ordering neurological consultation
b call the child protective service agency
c order a skeletal survey to look for old fractures.
d pulse oximetry
e lateral neck films
|
| drk1980
Forum Guru
Topics: 147
Posts: 1,038
|
A?
|
| drk1980
Forum Guru
Topics: 147
Posts: 1,038
|
on second thots maybe lateral neck films are not necessary if a CT is already done as mentioned in the Q...
|
| achilles
Forum Guru
Topics: 85
Posts: 1,201
|
this is a case of child abuse-shaken baby syndrome.
i am not quite sure of the answers but i'll go for C. skeletal survery should be obtained as soon as the child's condition becomes better.
___________________
" it's not whether you get knocked down, it's whether you get up"
" i have miles to go before i sleep "
|
| achilles
Forum Guru
Topics: 85
Posts: 1,201
|
skeletal survey is not really urgent right now considering the condition of baby...
about lateral xray i think it would be needed if the baby needs additional/aggressive respiratory support then any injury to the cervical spine must be ruled out.
but i am really not sure. hope yu have the answer to this one babli.
___________________
" it's not whether you get knocked down, it's whether you get up"
" i have miles to go before i sleep "
|
| srf
Forum Guru
Topics: 73
Posts: 405
|
archilles q asks least appropriate & not the most appropriate measure.
e
we already have ct additionaly we are going for skelatal survey so what is need for e?
___________________
life is reality without an eraser
|
| achilles
Forum Guru
Topics: 85
Posts: 1,201
|
well, for me, all five things need to be done. but just that skeletal survey at this point considering the baby's condition is not so urgent but definitely must be done once the baby is stabilised.
there is associated neck injury sometimes in shaken baby syndrome and therefore i was thinking about the lateral cervical spine xray.and the ct scan does not say that it included the cervical spine. lets wait for babli to answer this. what is your answer though ? what do you say ?
Edited by achilles on 04/14/06 - 08:07 AM
___________________
" it's not whether you get knocked down, it's whether you get up"
" i have miles to go before i sleep "
|
| infliximab
Forum Guru
Topics: 22
Posts: 320
|
B...... child abuse/shaken baby syndrome
|
| babli
Forum Guru
Topics: 40
Posts: 425
|
correct ans is E.
the infant has been abused & manifests classical presentation of SHAKEN BABY SYNDROME.retinal haem occur in 80-90% of the cases.subdural hematomas r also common.injuries r due to violent shaking of the child,who may be thrown against soft surface,such as bed.
a skeletal survey is used to document old fractures,which give further proof of abuse.the local agency that handles child abuse should be called,based only on suspicion-definite proof or parental confession is not required.
pulse oximetry is reasonable in setting of tachypnoea,which is likely due to subdural hematoma.neurological consultation is advised in setting of subdural hematoma,especially with lethargy,which should be considered evidence of neurological deterioration.lareral neck films are not needed as CT has been done.
|
| achilles
Forum Guru
Topics: 85
Posts: 1,201
|
good question babli.
___________________
" it's not whether you get knocked down, it's whether you get up"
" i have miles to go before i sleep "
|
| babli
Forum Guru
Topics: 40
Posts: 425
|
thanks achilles.
|
| chemamr
Moderator and PGY1
Topics: 703
Posts: 4,441
|
 agree with E.
you can check for spine injury (if needed) in a CT scan.
___________________
Any time something is written against me, I not only share the sentiment but feel I could do the job far better myself.
|
|
| |
| | | | | | | | | | | | |
