Pediatric emergency medicine trisk 3584 3584
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (100.2 KB, 1 trang )
pediatric trauma center should be considered if appropriate surgical or critical care
staff is not available.
Clinical Assessment
Evaluation of a child with trauma begins with a focused history and complete
physical examination. The history can be invaluable in identifying the potential
for cervical spine or cord injury. The following questions should be answered: (i)
What was the mechanism of injury? If a motor vehicle collision, was he or she
restrained, and at what angle did the car(s) collide? (ii) Was there a sports injury?
If so, did it involve a spearing motion? (iii) Did the child fall? If so, how high was
the fall and how did the child land? A neurologic history should be obtained for
evidence of paresthesias, paralysis, or paresis at any time after the injury. These
symptoms may have been transient and may (or may not) be present at the time of
the examination or volunteered by the patient, yet they are important because they
may suggest cervical contusion, concussion, or SCIWORA. The answers to these
and other historical questions can often be obtained from the patient, parents,
bystanders, and EMS personnel and can help determine the potential for cervical
injury. A plethora of clues can aid in the diagnosis of a cervical cord injury (
Table 112.6 ). The symptoms and signs may be obvious or masked by other
abnormalities such as altered level of consciousness, hypovolemic shock, or
concurrent head injury. Head and neck injuries may present with overlapping
abnormal neurologic signs, and differentiation of causation may be difficult. A
thorough examination, including a complete neurologic assessment, should be
completed.
