A 14-year old malnourished child (14 years) who is suffering from emotional trauma is rushed into the hospital with a forehead laceration that does not need stitches, a broken wrist, and brain hemorrhage caused by head trauma. How would she be treated? What medications would she be given? What would the recovery process be like? (Sorry, I know it's a lot of questions, but 10 points to the best answer.)
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Lily,
The child would be triaged. Vital signs and general condition would be determined. I would hope the child would see a physician sooner rather than later.
First, the police would be called. A record of traumatic injuries to a minor child would need to be documented. The nurses would send for prior medical records for this child. Staff might call to other hospitals seeking other records for this child which indicate physical abuse. Second, local social services would be notified and would need to speak to the child if possible, and start a casefile. Why is the child traumatized ? Why is the child malnourished ? While we are waiting for the social worker on call to get here, the child gets a CT scan of the head and an x-ray of the wrist. The forehead laceration would be assessed, and possibly secured to minimize scarring using dermabond. Routine bloodwork would be taken. She will get an IV access in order to administer steroids, mannitol, (to help to prevent too much fluid and swelling of the brain) and likely intravenous antibiotics.
The severity of the head trauma would determine what would happen next. She may be given steroids to decrease swelling, or she may head to the OR to surgically have pressure released in her brain. If she goes to the OR, then she may be typed and cross-matched for several units of blood. Depending upon her response to such a surgery, after recovery, she could be sent to the Intensive Care Unit, possibly a neurosurgical ICU, a pediatric ICU, or a general pediatric unit, depending upon the hospital and the facilities available at that particular institution. She will receive medication for pain and also antinauseants as we don't want a patient with recent brain surgery increasing intercranial pressure by vomiting.. Her vital signs will be frequently measured, and she may be on a cardiac monitor depending upon her tolerance to any procedures she had, and the standing orders for the unit she has been sent to. Her progression from the ICU to a regular unit and then out of the hospital would depend on her responses to treatment. Other drugs could be added depending upon changes in vital signs. It is essential that such a patient not experience hypertension post-operatively.
The child would be triaged. Vital signs and general condition would be determined. I would hope the child would see a physician sooner rather than later.
First, the police would be called. A record of traumatic injuries to a minor child would need to be documented. The nurses would send for prior medical records for this child. Staff might call to other hospitals seeking other records for this child which indicate physical abuse. Second, local social services would be notified and would need to speak to the child if possible, and start a casefile. Why is the child traumatized ? Why is the child malnourished ? While we are waiting for the social worker on call to get here, the child gets a CT scan of the head and an x-ray of the wrist. The forehead laceration would be assessed, and possibly secured to minimize scarring using dermabond. Routine bloodwork would be taken. She will get an IV access in order to administer steroids, mannitol, (to help to prevent too much fluid and swelling of the brain) and likely intravenous antibiotics.
The severity of the head trauma would determine what would happen next. She may be given steroids to decrease swelling, or she may head to the OR to surgically have pressure released in her brain. If she goes to the OR, then she may be typed and cross-matched for several units of blood. Depending upon her response to such a surgery, after recovery, she could be sent to the Intensive Care Unit, possibly a neurosurgical ICU, a pediatric ICU, or a general pediatric unit, depending upon the hospital and the facilities available at that particular institution. She will receive medication for pain and also antinauseants as we don't want a patient with recent brain surgery increasing intercranial pressure by vomiting.. Her vital signs will be frequently measured, and she may be on a cardiac monitor depending upon her tolerance to any procedures she had, and the standing orders for the unit she has been sent to. Her progression from the ICU to a regular unit and then out of the hospital would depend on her responses to treatment. Other drugs could be added depending upon changes in vital signs. It is essential that such a patient not experience hypertension post-operatively.
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