• Scene – exam
• En Route – vitals, exam
• Hospital – exam only no x-rays or MRI
• Response to treatment – pt did well with medics
• After the video was taken, I picked him up and held him while I asked the caregiver more questions, and he fell asleep in my arms.
• Mark Shelton Paramedic Woodburn Ambulance
• David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center
• Altered mental status
• Concussion
• Concussion
• Closed head injury
• Non-accidental trauma and/or neglect
• Fracture of the skull or other bones
• Hematoma
• Seizure
• Patient states – the pt only cries on scene. En route he is able to answer simple questions and interacts with medics. He mostly slept en route but was pretty easily aroused.
• Caregiver states – pt was on the back of a couch when he pushed on the screen and it gave way. Distance from the top of the couch to the ground is 3 ft or less. The pt was found on his hands and knees. Mom says the pt is pretty fast though and may have moved to that position quickly after the fall.
• Physical findings – none; No trauma noted to head back, neck, extremities
• CBG – not taken
• BP – 92/53 taken with zoll
• GCS – 15
Falls can cause serious injury. Information from the scene, including height of the fall, ground surface, and appearance of the child at the scene is helpful for the emergency physician upon arrival at the hospital. Assessing whether the child can walk is also important, if possible. This child seems “clingy” and a bit sleepy. This may suggest concussion, but an intracranial event must also be considered (epidural hematoma). Assessment for neglect is a key aspect of scene care with falls (accidental vs non-accidental).
-Dr. David Spiro
• Gender: Male
• Age: 2 years
• Height: Not Available
• Weight: Not Available
• Temperature: Not Available
• Blood Pressure: 92/53
• Heart Rate: 85
• Respiratory Rate: 24
• Pulse Oximetry: 98% RA
Sleepy, crying
• Dispatch info: Fell out of window Social
• Pt is at daycare today, with a babysitter who has watched the child for most of his life. There are two other children in care, ages 1 and 3.
• None
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