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Tue Jul 10 16:33:26 BST 2007

 2 year old child came to our Trauma centre after fall from about 10 feet height. The child  on admission  was not vocalizing , otherwise she was conscious ,  localizing on stimulus, and had spontaneous eye opening. She had an episode of vomitting before arriving to our centre.Previously the child used to talk normal for her age.The child had open anterior fontanelle which was pulsatile and not tense.
CT Head was done which showed frontal EDH on right side with maximum thickness of about 1 cm .(Photograph attached) The query is does patient need surgical evacuation considering size of EDH and GCS of the patient? . Does non tense and pulsatile fontanelle warrant conservative management?

Another one and half year child came with history of blunt abdominal trauma due to motor vehicle accident . Patient was stable hemodynamically .No other sign and symptoms except for tenderness in upper abdomen . USG - Free fluid and spleenic contusion. CT abdomen  confirmed USG finding with additional diagnosis of left renal artery thrombosis. The  left kidney showed  major devascularisation except for a small wedge. It showed some excretion of dye on delayed films.
The dilemma was whether surgical intervention is needed ? If not when should the conservative management be aborted . (CT Attached)

Thanking you for your views.

Dr. Navin Goyal
Dr. Suhail Yaqoob
Mumbai, INDIA.

Please Note : could not attach CT Photograph due to size problem

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