 |
 |
Always difficult when they seem to have recovered from a severe insult - I've had this problem with pulseless drowned kids who've had good BLS at the poolside by passing docs. etc. Bearing in mind the compliancy of the chest wall at theis age the risk of chest injury must be very high - certainly CXR looking for widened mediastinums, cardiomegaly, pul contusions etc. Might consider an echo - if not I'd do an ECG. Difficult to know how far to take the raised intravascular pressure in the head combined with hypoxia- I'd admit overnight for observation rather than faffing round with CTs (and GAs etc at this age). But I don't know the answer. Good way to measure the degree of hypoxia they've sustained is to look for a residual metabolic acidosis by doing a venous bicarb - the bicarb often takes some time to really get back to normal. (Or a blood gas) Fiona Jewkes ----- Original Message ----- From: "Goat" <[log in to unmask]> To: <[log in to unmask]> Sent: Friday, March 08, 2002 3:59 PM Subject: Chest compression clinical question > 3-year old female child, pinned face-up onto soft ground across chest by > tree trunk which rolled on to her form back of a pick-up. Cyanosed and > unconscious 5-10 minutes. On arrival, fully recovered apparently. Only > sign: densely-spaced petechiae in SVC distribution. > > Your management suggestions please: > Discharge / admit? > Investigate / observe? > > Dr G Ray > A&E > Sussex > Reply to [log in to unmask] >