Life-Threatening Fall
Life-Threatening Fall
Matthew, a 3-year-old boy, was transported to the emergency department (ED) via helicopter after sustaining life-threatening injuries in a fall from a 3rd story window. Matthew had fallen head-first from the window, impacted a drain-pipe with the side of his head, and landed on a concrete sidewalk. It was noted at the scene that his pupils were fixed and dilated, he was not spontaneously breathing, and he was bradycardic. He was intubated in the field and flown to the ED. After CT scanning, Matthew was transferred to the pediatric intensive care unit (PICU) for further stabilization and evaluation.
Upon admission to the PICU, Matthew presented as follows:
Vital Signs: HR 188, RR 16 per ventilator with no spontaneous respirations, BP 65/28 (32), O2 Saturation 100%, 34.5 C degrees rectal temperature.
Neurological: Pupils fixed and dilated at 8 mm, a Glasgow Coma Scale score of 3, ICP of 12 mmHg with cerebral perfusion pressure (CPP) of 20 mmHg, no spontaneous respiratory effort, no spontaneous movement of extremities.
Cardiovascular: HR 130-180s, with dopamine and norepinephrine drips to keep MAP 40-80 mmHg, pulses 1+ throughout, CFT 6 seconds, pale and cold.
Respiratory: 4.5 endotracheal tube at 12.5 cm; ventilator settings FI02 100%, Mode PRVC, TV 200, IMV 16, PEEP 5; frothy, bloody secretions from ETT.
Skin/Skeletal: Multiple facial and skull fractures resulting in gross swelling and bruising over entire face, large laceration and bruise on right side of head extending from hairline to below jaw, minor lacerations and bruising to both palms and knees.
GI/GU: 8 French indwelling temperature urinary catheter, 10 French Salem-Sump nasogastric drainage tube. Clear urine and bloody, bilious stomach fluid.
Upon admission to the PICU, Matthew presented as follows:
Vital Signs: HR 188, RR 16 per ventilator with no spontaneous respirations, BP 65/28 (32), O2 Saturation 100%, 34.5 C degrees rectal temperature.
Neurological: Pupils fixed and dilated at 8 mm, a Glasgow Coma Scale score of 3, ICP of 12 mmHg with cerebral perfusion pressure (CPP) of 20 mmHg, no spontaneous respiratory effort, no spontaneous movement of extremities.
Cardiovascular: HR 130-180s, with dopamine and norepinephrine drips to keep MAP 40-80 mmHg, pulses 1+ throughout, CFT 6 seconds, pale and cold.
Respiratory: 4.5 endotracheal tube at 12.5 cm; ventilator settings FI02 100%, Mode PRVC, TV 200, IMV 16, PEEP 5; frothy, bloody secretions from ETT.
Skin/Skeletal: Multiple facial and skull fractures resulting in gross swelling and bruising over entire face, large laceration and bruise on right side of head extending from hairline to below jaw, minor lacerations and bruising to both palms and knees.
GI/GU: 8 French indwelling temperature urinary catheter, 10 French Salem-Sump nasogastric drainage tube. Clear urine and bloody, bilious stomach fluid.
Matthew, a 3-year-old boy, was transported to the emergency department (ED) via helicopter after sustaining life-threatening injuries in a fall from a 3rd story window. Matthew had fallen head-first from the window, impacted a drain-pipe with the side of his head, and landed on a concrete sidewalk. It was noted at the scene that his pupils were fixed and dilated, he was not spontaneously breathing, and he was bradycardic. He was intubated in the field and flown to the ED. After CT scanning, Matthew was transferred to the pediatric intensive care unit (PICU) for further stabilization and evaluation.
Upon admission to the PICU, Matthew presented as follows:
Vital Signs: HR 188, RR 16 per ventilator with no spontaneous respirations, BP 65/28 (32), O2 Saturation 100%, 34.5 C degrees rectal temperature.
Neurological: Pupils fixed and dilated at 8 mm, a Glasgow Coma Scale score of 3, ICP of 12 mmHg with cerebral perfusion pressure (CPP) of 20 mmHg, no spontaneous respiratory effort, no spontaneous movement of extremities.
Cardiovascular: HR 130-180s, with dopamine and norepinephrine drips to keep MAP 40-80 mmHg, pulses 1+ throughout, CFT 6 seconds, pale and cold.
Respiratory: 4.5 endotracheal tube at 12.5 cm; ventilator settings FI02 100%, Mode PRVC, TV 200, IMV 16, PEEP 5; frothy, bloody secretions from ETT.
Skin/Skeletal: Multiple facial and skull fractures resulting in gross swelling and bruising over entire face, large laceration and bruise on right side of head extending from hairline to below jaw, minor lacerations and bruising to both palms and knees.
GI/GU: 8 French indwelling temperature urinary catheter, 10 French Salem-Sump nasogastric drainage tube. Clear urine and bloody, bilious stomach fluid.
Upon admission to the PICU, Matthew presented as follows:
Vital Signs: HR 188, RR 16 per ventilator with no spontaneous respirations, BP 65/28 (32), O2 Saturation 100%, 34.5 C degrees rectal temperature.
Neurological: Pupils fixed and dilated at 8 mm, a Glasgow Coma Scale score of 3, ICP of 12 mmHg with cerebral perfusion pressure (CPP) of 20 mmHg, no spontaneous respiratory effort, no spontaneous movement of extremities.
Cardiovascular: HR 130-180s, with dopamine and norepinephrine drips to keep MAP 40-80 mmHg, pulses 1+ throughout, CFT 6 seconds, pale and cold.
Respiratory: 4.5 endotracheal tube at 12.5 cm; ventilator settings FI02 100%, Mode PRVC, TV 200, IMV 16, PEEP 5; frothy, bloody secretions from ETT.
Skin/Skeletal: Multiple facial and skull fractures resulting in gross swelling and bruising over entire face, large laceration and bruise on right side of head extending from hairline to below jaw, minor lacerations and bruising to both palms and knees.
GI/GU: 8 French indwelling temperature urinary catheter, 10 French Salem-Sump nasogastric drainage tube. Clear urine and bloody, bilious stomach fluid.
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