 | Brain Food is a project to drip feed clinical knowledge (in the form of mock SAQs) to satisfy those hungry neurons. Sources are SA/NT Trial Exam 2021.2 and Monash 2022.1. Answers are prone to ageing. Leave a comment if you don't understand or something doesn't seem right... PS we don't use the mock questions uploaded to ACEMs official mocks |
A 20-month-old boy has been driven to a metropolitan Emergency Department by his mother. She stated to the Triage Nurse that the boy was playing outside when she heard him cry.
On going outside, she found him lying on the ground. He was awake but upset.
He has a 2 x 2 cm contusion over his left forehead with a small overlying abrasion.
The boy has no known medical history or allergies and has never been to this
Emergency Department before. The family have only just moved into the area.
Two hours after the stated injury the child is being observed in the Paediatric Area. The nurse has alerted you to his mother wanting to take him home.
The mother is becoming agitated and her disruptive behaviour is upsetting both the staff and other patients.
You suspect that the boy’s mother is intoxicated, and she has already left the child with nurses on two occasions to go outside for a cigarette.
On going outside, she found him lying on the ground. He was awake but upset.
He has a 2 x 2 cm contusion over his left forehead with a small overlying abrasion.
The boy has no known medical history or allergies and has never been to this
Emergency Department before. The family have only just moved into the area.
Two hours after the stated injury the child is being observed in the Paediatric Area. The nurse has alerted you to his mother wanting to take him home.
The mother is becoming agitated and her disruptive behaviour is upsetting both the staff and other patients.
You suspect that the boy’s mother is intoxicated, and she has already left the child with nurses on two occasions to go outside for a cigarette.
1. Apart from contusion, state four (4) examination findings that would indicate an increased risk of significant head injury.
- Lethargy or irritability
- Seizure/s
- >3 vomits
- Decreased GCS
- Focal neurological findings, significant haematoma (>3cm frontal, >1cm non frontal), suspected NAI, depressed skull #, penetrating trauma
2. What five (5) criteria need to be met before you can safely discharge this child?
- Exclude significant head injury - no listed signs from above
- Responsible adult to care for child, not intoxicated mother
- Safe transport home
- Risk assessment of home situation with limited knowledge to ensure it's safe for child
- Head injury discharge advice with clear direction as to when to return and Red Flags
- Any previous reports of neglect or abuse from previous hospital or GP if available.
The mother is now walking out of department with her son. You have not formally discharged him.
3. What three (3) key steps now need to be taken?
3. What three (3) key steps now need to be taken?
- Make a formal report to Child Abuse Report Line
- Attempt to reason with the mother
- Call mother later to check on child
- Involve police to ensure welfare check occurs
RSS Feed
