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C. García Mauriño, A. Molina García
Residentes hospital infantil universitario La Paz
7. Patient with head trauma in the emergency department
Paediatrician: Hello, my name is Dr. Shelby, what can I do for you?
Mother: Hello, I came to the hospital because my son Isaac has hit his head while he was playing on the swing this afternoon at the playground and i’m worried he is bleeding inside his head because he has hemophilia.
Paediatrician: At what time was the incident? Have you noticed anything wrong in his attitude after the trauma?
Mother: I wasn’t there when this happened, but the teacher who was with him said he was trying to jump on the swing when she heard a big noise. She turned around and saw Isaac on the floor unconscious for a few seconds. Then he started crying.
Paediatrician: After that, has the boy vomited? Any convulsions/seizures?
Mother: Well, when i went to pick him up after his teacher called, she said he had vomited twice. He wants to sleep all the time, but every now and then he seems to be irritated about something and he starts crying. I haven’t seen him make any strange movements.
Paediatrician: At what time did this happened? When was the last time he had something to eat?
Mother: This happened after lunch time, around 1:00pm, approximately an hour ago. After lunch he hasn’t had anything else to eat or drink, should i give him something? He has just vomited while we were outside in the waiting room.
Paediatrician: No, he can’t eat or drink anything for now. How old is he? What type of hemophilia does he have? Does he have any allergies or previous illnesses?
Mother: He is only 3 years old and he has hemophilia A. He is also allergic to amoxicillin. Is he going to need any extra tests?
Paediatrician: After examining the boy, it is obvious that he has a tendency to sleep and doesn’t want, or is not able to stand up. I can also feel a skull deformity in the occipital bone. The rest of the examination seems fine. I am concerned that Isaac might have a cerebral haemorrhage. We are going to ask for a head CT scan to rule out this possibility and call the Haematologist so he can evaluate Isaac and decide if he needs a dose of clotting factor to avoid the bleeding. While I do this, our nursing staff will proceed to measure his vital signs and take a blood sample to perform, amongst others, coagulation tests. He can’t eat because he will probably need anaesthetic induction in order to be able to perform the CT scan correctly, as he can’t move during this procedure.
KEY WORDS:
Consciousness: conciencia.
Headache: cefalea.
Head trauma: traumatismo craneal.
Antipyretic: antitérmico.
Febrile seizure: crisis febril.
Neurodevelopmental outcome: desarrollo neurológico.
Diminish her IQ: empeorar su cociente intelectual.
Subjacent neurological disorder: alteración neurológica subyacente.
Sleepy: somnolienta.
