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COngratulations!!!
Could answer these qs:
If you have a child abuse case on ccs and the child has an intracranial hemorrhage, what do you do first contact child protective services or call neurosurgery consult. And also we can`t admit him to the hospital from ER until we manage the intracranial blled, right? If we admit stabilized child, do I admit to regular ward?
Second q: If child with intussuseption comes to your office, do you send him to ER or you do Barium enema immediately at the office?
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Call Neurosurgery consult & then inform CPS.
For Barium enema you will have to send the patient to the hospital..but Barium enema is the key, although you have to make sure the child is well hydrated & pain free..
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calcium those2 cases came to my exam
for intussc case you must do barium enema in the office and then transfere the patient diredctly to the floor ( not ER)for observation
for child abuse after stbalize the pat ,call neurosurg and admitte to the floor not icu
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calcium as many have said first thing is to treat your patient and stabilize.
You can't have pt in ED for a long period of time care and attention is not optimal there and perhaps it's also expensive. What you should do is do CT scan stat, then call neurosurg (if midline shift or signs of ICHTN) else call neurosurg but also move pt to PICU and call neurology. I have to disagreee with rampo, patient needs at least step down unit with neurology checks q2-4 hours this patient will have edema and can herniate at any time and floor is not the optimal level of care..... Must treat to prevent ICHTN and reduce risk for herniation....sometimes they will need ventriculostomy, remember to give mannitol and check elsewhere. Telemetry, and close monitoring is needed (I see this all the time so I do know what I am talking about!) You must to full body Xray scanning to look for other lesions/occult bleeding. And then yes, call to report etc.
So if pt is NOT stable or is at risk patient care comes always first!
Best
BDJ
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Thanks BDJ, I was thinking about ventricostomy too, but this choice is not available on sample CD
