Severe Traumatic Brain Injury in Children: An Evidence-Based Review of Emergency Department Management (Trauma CME and Pharmacology CME) - $49.00
Publication Date: October 2016 (Volume 13, Number 10)
CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. CME expires 10/1/2019
Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma CME and 1 Pharmacology CME credits, subject to your state and institutional approval.
Excerpt From This Issue
A 22-year-old mother of 3 brings her 3-month-old boy to the ED, stating that he has not been feeding well. She is vague in her description of the child’s symptoms. The nurse calls you into triage because she notes the child appears unresponsive. The mother denies any trauma. The infant’s vital signs are as follows: afebrile; heart rate, 160 beats/min; blood pressure, 70/40 mm Hg; respiratory rate, 30 breaths/min; and oxygen saturation, 93% on room air. You struggle to calculate a GCS score, as this patient is not yet verbal. On physical examination, the child is minimally responsive and has irregular and shallow respiration, so you prepare to intubate. During placement of an IV line, the child flexes his left arm in response to pain, but no spontaneous movement of the right arm or leg is noted. During the secondary survey, you note a bulging fontanelle and a dilated left pupil, with deviation of the left eye both downward and peripherally. You have the clerk page neurosurgery emergently. The respiratory therapist asks you if you would like to hyperventilate the patient. What should your target PaCO2 level be? What medication(s) should be given immediately? Once stabilized, are there any other services or specialists that should be involved with this patient, based on the history?