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Penetrating Skull Injures in Children - How would you handle this?
Make Believe Story: You arrive on scene and find a young boy who's father had been drinking too much while throwing darts. From the lack of visible metal from the dart
tip, you can assume the dart entered the skull over 1-inch deep. You arrive on scene... now what?
Update: I can't believe I was able to find the actual medical article and photos for this incident. For the purposes of this post, I invented the scenario but now that there have been a significant number of responses, here's the real story...
The Real Story: A ten-year-old child was playing darts with his older brother. He went to retrieve his throw from the dartboard when an errant toss struck him above the right eye. A case report... (Full Story)
Here's the X-Rays:
Replies to This Discussion
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Permalink Reply by Justin Buck on
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I would call in a medical helicopter and tell EMS Unit to hurry Up. But on a serious note i would go ahead check vitals and then ell EMS Units thats responding to HURRY UP!!!
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Permalink Reply by WestPhilly on
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Dad was thisclose to a bullseye.
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Permalink Reply by Mike Schlags (Captain Busy) Retd on
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Permalink Reply by Dwayne on
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Yes get the vitals, stabilize the object and transport vitals will dictate further care en route.
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LMAO
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Dwayne,
Outstanding!
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Permalink Reply by John Crabbe on
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Stop looking for zebras and focus on the basics...ABC's Got an airway? OK, are they breathing? OK, circulation? OK. then stabilize the object in place (rolled gauze on either side and cling around the head will work fine) and transport. Yeah it is a kid, but so what, no need to lose focus of the task at hand because of it.
I have a problem with this:
i would go ahead check vitals and then ell EMS Units thats responding to HURRY UP!!!
Why tell them to hurry up? What do you think that does? you have a driver in an ambulance (most likely) driving in traffic with unpredictible drivers, trying to get to the scene. They hear "it's a kid and HURRY UP" what the heck do you think the person is going to do? Most likely speed up right? So what the hell happens then if the ambulance crashes or something? Then what? How long do you think it will be before another ambulance gets there? You're no good to anyone if you don't get to the scene safely....if that means slowing down and driving with Due Regard, then so be it.......bottom line, there is no reason to tell anyone to "hurry up". It is better to paint a picture and relay important information like "The pt is concsious and breathing, vitals stable, pt is able to move extremeties, object is stabilized" etc. If the pt is crashing, then relay that information, but don't be fooled by looking for zebras, concentrate on the ABC's and the transporting rig will arrive when they do SAFELY, vs "hurry up".
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Permalink Reply by Oldman on
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There is absolutely no reason to go apeshit over this scene. A calm, unhurried approach is what is needed in this situation.
ABC's intact, the priority would be to stabilize the dart.
Vital signs and transport to a Level 3 or better trauma center.
Helicopter? Maybe, but not a necessity unless you have a prolonged transport time.
If one looks at the position of the dart, it is in the right frontal sinus and the angle suggests there is a strong probability it did not enter the cranial cavity. Naturally x-rays will confirm or deny this.
Folks, there is a a big difference between doing things quickly, and doing things in a hurry. When we get in a hurry, things will be missed and or done incorrectly. We can do things quickly, but without hurrying, and the end result will be better.
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Permalink Reply by Station10Capt106 on
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well, from the photo the child seems to be stable. I would approach the scene (ensure scene safety since there is a suspected drunk father). I would keep myself calm, thus helping the child keep calm and start my assessment.
Obviously check the ABC's. I would stabilize the dart in place with some gauze. Do a physical exam to see if there is any other trauma involved (from falling or hitting head after dart hit him). Check O2 stats and if low apply a nasal canula or non-rebreather if needed. Consider C-spine stabilization if head hit anything after event.
As Oldman said, you want to work quickly on almost every patient, but do so in a controlled calm manner. How you react sets the tone and greatly affects the agitiation and confidence of the patient.
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Permalink Reply by Firewriter on
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Ouch ... but true!
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Permalink Reply by Norm Tindell on
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Cap sums it all up very well.
I think CBZ threw in the pediatric aspect just to try to throw us off. In fact, the situation doesn't warrant any different protocol.
The most important aspect of our reponse in a situation such as this is, as Cap wrote, that we conduct ourselves in a calm and methodical manner so the child doesn't become more afraid.
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Dwayne,
Concise and right on the money!! Excellent answer!!
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