Evidence-Based Management Of Pediatric Genitourinary Tract Injuries In The ED - $30.00
This issue includes 4 AMA PRA Category 1 CreditsTM; 4 ACEP category
1 credits; and 4 AAP Prescribed credits.
Joyce C. Arpilleda, MD, FAAP
Associate Clinical Professor of Pediatrics, Rady Childrenís Hospital and Health Center, University of California San Diego, San Diego, CA
Thomas Abramo, MD, FAAP, FACEP
Professor of Emergency Medicine and Pediatrics; Director, Pediatric Emergency Department, Monroe Carell Jr. Childrenís Hospital at Vanderbilt, Nashville, TN
Robert A. Wiebe, MD
Professor, Division of Pediatric Emergency Medicine, University of Texas, Southwestern Medical Center at Dallas, Dallas, TX
Publication Date: May 2010; Volume 7, Number 5
Excerpt from the issue...
An 11-year-old female presents with abdominal pain, vomiting, and left arm pain after being injured by a horse. The horse was standing on the patientís right side when it was spooked and bumped into her. She fell to the ground but was not sure whether or not she had been directly kicked by the horse. Vomiting and abdominal pain developed after she was back at home, approximately 30 minutes after the incident. Upon her arrival at the triage area of the ED, the patient discovered that she had gross hematuria. Her initial vital signs on triage included a blood pressure of 106/60 mm Hg, a heart rate of 90 beats per minute, and a respiratory rate of 20 breaths per minute. Physical examination revealed pallor during retching, a chin abrasion, a horseshoe-shaped contusion over the right lateral ribs, and tenderness in the abdominal right upper quadrant and right flank. Bilateral peripheral intravenous catheters were placed, and 0.9% normal saline solution (20 mL per kg of body weight) was administered in the ED.
What are the priorities in the initial evaluation and management of this child? How would you evaluate this possible renal injury?