When would you obtain a CT for a pediatric patient who sustained a head injury? Watch this nice 11-minute video review by Dr. Raul Patwari, discussing the 2009 Lancet PECARN study.
MIA 2012: Pearce MS et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet. 2012 Aug 4;380(9840):499-505.
Bottom Line 1
Interpret this data how you will: Exposure to 2-3 CT scans of the head will triple the risk of brain tumors; 5-10 head CT scans will triple the risk of leukemia. In absolute terms, this translates into approximately 1 excess case of leukemia and 1 excess brain tumor per 10,000 patients.
Fracture or a normal ossification center?
This is a common question heard when viewing an xray of a pediatric elbow. How do you remember the timing of normal ossification centers? FYI, the xray images above are normal and have no fractures.
Is this coin in the esophagus or the trachea?
The classic teaching for the Boards exam is:
- Esophageal coins appear in the coronal plane, as shown above.
- Tracheal coins appear in the sagittal plane because of the cartilaginous tracheal rings.
Having you had trouble seeing a pediatric patient’s tympanic membrane because of impacted cerumen? Scared from that last time you used a rigid curette and caused bleeding in the ear canal? The parents are worried that you hit the brain…
Kawasaki Disease can be easy to diagnose when you have the pediatric patient, who presents with all 5 of the classic clinical findings. What happens when you have the prerequisite fever for ≥5 days, but only 2-3 clinical criteria?
- What ARE the 5 classic findings?
- When do you do waitful watching?
- When do you perform an echo?
- When do you treat empirically?
Check out the nice flowchart below which addresses these questions. They summarize the most recent (2004) American Heart Association’s consensus group’s recommendations.