• Scene treatment – rapid exam
• En route – pulse oximetry, secondary exam, social history
• Hospital – not known
• Unknown
• Elliot Williams, Paramedic Woodburn Ambulance
• David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center
• Excluding infant trauma
• Blunt abdominal trauma
• Closed head injury or concussion
• Intracranial bleed (eg, epidural hematoma)
• Non-accidental trauma – evaluate for child abuse
• Fracture (esp long bone, ribs)
• Upon arrival, patient in car seat with mom attending.
• Mom states she doesn’t know how long she was sat on for or how hard, dad weighs ~180 lbs, states she was quiet after getting up and then started crying. She stopped crying but would take some sharper deep breaths, and would cry when she did that, unk how often. Dad not on scene. Occurred at 0615, 911 call at 0646.
• Physical exam was atraumatic, lung sounds clear, no CSF or blood noted from ears, fontanel normal, not crying, normal cooing. Skin PWD.
These scenarios can be horrifying and anxiety-producing for families. The fact that this call was made immediately post-incident may make non-accidental trauma less likely, but not excluded. It is incumbent upon the EMS provider to perform a careful exam, assess and reassess vitals, and evaluate the scene for possible clues of neglect. Concerning the father was not on scene – he should be interviewed by the ED after arrival.
-Dr. David Spiro
Child abuse
Pediatric abdominal trauma
Pediatric head trauma
• Gender: Female
• Age: 7 weeks
• Height: Not Available
• Weight: Not Available
• Temperature: Not Available
• Blood Pressure: Not Available
• Heart Rate: 180
• Respiratory Rate: 50
• Pulse Oximetry: 98% RA
• PMH: Patient born full-term with no complications, no meds, allergies, or medical problems. Only one newborn check-up so far.
• Dispatch: Dispatched as breathing issue, states patient was sat on by dad, now crying.
• Social: Lives with mom and dad, one older sibling. Mom states she sleeps with the baby on their mattress with lots of blankets, baby sleeps face down. Advised the hospital of this, they told me they would try to educate mom about risks of having baby sleeping with parents.
• None
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