Case 1 - Marina

  • You are a clinician working in an emergency department in Queensland.
  • You are about see an 18 month old female called Marina who was brought in by her mother Monica. Monica tells you that Marina fell from the couch onto her head 30 minutes ago.
  • She had climbed onto the couch, and then fell off and onto the back of her head. This was witnessed by Monica who was a few metres away. Marina cried right away. There was no loss of consciousness. Monica feels that she is now back to her normal self. She has not identified any bruises or swellings.
  • Observations: RR: 25   O2: 100%   T: 36.5   HR: 120
  • There were no relevant or concerning findings on perinatal history, developmental history, medical history, medications, allergies, vaccinations, family history, and social history.
  • You have done a thorough examination and all of your findings are consistent with a normal examination.

Questions to discuss about Marina’s case

  • How would you classify Marina’s head injury?
    • Discuss the process of risk stratifying head injuries in children?
    • Discuss features that classify a child as ‘low-risk’, intermediate-risk’ or high-risk’
  • What should you consider in your history and examination?
  • What should you consider if the extent of injury is not consistent with the mechanism provided?
  • How would you manage Marina? Discuss the use of antiemetics for vomiting in head injury.
  • What are some signs of raised ICP?
    • What is the management of raised ICP?

Normal range for vital signs by age

Normal range for vital signs by age based on Childhood Early Warning Tool (CEWT)
Age Heart rate (bpm) Minimum Systolic BP (mmHg) Respiratory Rate (bpm)
<1 year old 100-159 <75 21-45
1-4 year old 90-139 <80 16-35
5-11 year old 80-129 <85 16-30
12-17 year old 60-119 <90 16-25

Case 2 - Jake

  • You are a clinician working in an emergency department in Queensland.
  • You are about to see a 6 year old male called Jake who was brought in by ambulance as a CAT 1.
  • He was involved in a high speed motor vehicle accident (MVA). His father was the driver and is currently intubated and ventilated in the adult emergency department. Jake was sitting in the backseat behind his father but was not using a car seat. He was wearing his seat belt. The airbags were deployed.
  • He is currently in a soft C spine collar.
  • Observations: RR: 25   O2: 97%   T: 37.2   HR: 170

Questions to discuss about Jake’s case

  • What history should you take?
    • Discuss conditions that may predispose to C spine injury.
    • What is the difference between pain and tenderness in a suspected C spine injury?
    • What are some risk factors for cervical spine injury in children?
  • What investigation should you perform to identify a C spine injury for a patient with a highly concerning mechanism?
  • What is the moments of risk (MOR) approach to immobilisation?
    • Discuss appropriate neck collars and the role of thoracic elevation devices.
  • What is your approach to a child with the following scenarios (as it relates to C spine injury)?
    • No risk factors or pain as the only risk factor.
    • Risk factors who is unstable.
    • Risk factors who is stable.

Normal range for vital signs by age

Normal range for vital signs by age based on Childhood Early Warning Tool (CEWT)
Age Heart rate (bpm) Minimum Systolic BP (mmHg) Respiratory Rate (bpm)
<1 year old 100-159 <75 21-45
1-4 year old 90-139 <80 16-35
5-11 year old 80-129 <85 16-30
12-17 year old 60-119 <90 16-25

Case 3 - Sneha

  • You are a clinician working in an emergency department in Queensland.
  • You are about see a 11 year old female called Sneha who presents with her mother Vidya. Her main complaint is a painful headache. She has been complaining of a 6 hour, bilateral, 8/10, pulsating headache. This is made worse by activity and somewhat improved with rest. She is also experiencing nausea, and has vomited twice. She reports mild photophobia and phonophobia. There is no history of fevers or other infective symptoms.
  • Observations: RR: 20   O2: 100%   T: 37.0   HR: 85
  • There were no relevant or concerning findings on perinatal history, developmental history, medical history, medications, allergies, vaccinations, family history, and social history.
  • You take a detailed history and examination. You do not identify any red flags suggestive of serious underlying pathology.

Questions to discuss about Sneha’s case

  • What are some primary and secondary headache disorders in children to consider?
  • What should you consider in your history and examination of Sneha?
  • What are some red flags suggestive of serious underlying pathology?
  • How would you investigate Sneha?
  • How would manage Sneha? Consider the side effects of this treatment and how you would manage this.

Normal range for vital signs by age

Normal range for vital signs by age based on Childhood Early Warning Tool (CEWT)
Age Heart rate (bpm) Minimum Systolic BP (mmHg) Respiratory Rate (bpm)
<1 year old 100-159 <75 21-45
1-4 year old 90-139 <80 16-35
5-11 year old 80-129 <85 16-30
12-17 year old 60-119 <90 16-25

Last updated: March 2024