• Scene – exam, VS, stabilized C-spine, packaged in car seat with towel to stabilize head
• En route – VS
• Hospital – CT scan
• Response to treatment – no changes.
• Disposition – discharged to home.
• Patient fell 2.5 times own height (estimated), patient less than 5 years old, patient acting lethargic. Entered into trauma system.
Authors:
• Elliot Williams, Paramedic Woodburn Ambulance
• Daniel Neazor, Paramedic Woodburn Ambulance Service Editors:
• David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center
• Fall
• Rule out closed head injury
• Rule out non-accidental trauma
• Concussion
• Closed head injury
• Non-accidental trauma and/or neglect
• Fracture of the skull or other bones
• Hematoma
• Seizure
• Caregiver states – Patient was left for less than 10 seconds on the bouncy chair on top of the table. Patient’s 10-month-old cousin was in a chair next to the table and pulled the patient in her chair down to the ground.
• Unknown if patient lost consciousness; patient did not immediately cry after fall, but did a few seconds after.
• Patient was found face down with chair on top of her.
• Upon arrival, mom stated that the patient “is trying to go to sleep.” Mom was at the sink holding the child and splashing patient’s head with cold water when we walked in.
• Physical findings – No obvious signs of trauma to patients face, head, arms, legs.
• Patient’s fontanelle is neither depressed nor swollen.
• Patient is acting somewhat lethargic; cries vigorously during primary exam and while being put into car seat, but when patient is held by mom or allowed to just sit in chair, patient falls asleep. Patient is easily roused with painful stimulation.
• GCS – 4/4/6
Children generally start to roll over at 3-4 months of age. Therefore, the parents of a 7 week old child “falling off a table” need to be further questioned about mechanism. Non-accidental trauma (NAT) should be considered in the differential diagnosis.
Suggested References
• Gender: Female
• Age: 7 weeks
• Height: Not Available
• Weight: Not Available
• Temperature: Not Available
• Blood Pressure: Not Available
• Heart Rate: 125
• Respiratory Rate: 38
• Pulse Oximetry: 98% RA
Fall
• PMH: Born a couple days late, otherwise healthy and normal.
• Dispatch info: Fall from 4′ to hard floor while restrained in bouncy chair.
• Aunt watches patient while parents work.
• None
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