Welcome to Megahuge!

Dr. Nicholas Superdoc, MD

Congratulations Dr. Superdoc, you’ve made it! Four years of mind numbing labor in medical school has finally paid off – you landed the highly coveted pediatric internship at Megahuge. Today you might be just “the intern” but soon you will be Dr. Nicholas G. Superdoc – pediatrician to the stars…

“Nick … Nick … hey Gunner – you awake?” Unfortunately, you are. As your daydream subsides you find yourself in continuity clinic at 4:30 on a Friday. “Hey Nick – this kid just came in as a walk in. Your 4:00 canceled so she’s all yours.”

In the exam room you meet Nevaeh Smith and her mother Abcde. Ms. Smith explains that Nevaeh is a two month old well child, with no health concerns. Ms. Smith indicates that two days ago she put Nevaeh in the middle of mother’s bed to sleep. About 5 minutes later, mother heard Nevaeh crying and returned to find her, lying on her left side, on the floor near the bed. Mother reports that the patient must have rolled off the bed. Nevaeh cried for a minute or two, but then she was OK.

Mother indicates that Nevaeh has been “colicky” and crying a lot recently. Nevaeh has not been feeding well over the past few days, and has spit up more than normal. When mother was bathing Nevaeh today, she felt a squishy spot on the patient’s head. Mother brought the patient directly to clinic.

On examination the patient is alert and interactive. Height, weight, and head circumference are at the 23rd percentile, just like they were at the 1 month visit. You notice a small bruise on the pinna of the left ear. The left side of Nevaeh’s head is mildly swollen, boggy, and tender when you palpate it. Her examination is otherwise normal.

An x-ray shows:

You wisely order a non-contrast head CT, the CT shows only the skull fracture noted on the skull x-ray.

What do you do next?

Schedule a follow-up in two weeks. Kids fall off beds all the time. It’s not dangerous as long as the head circumference stays normal.

Reporting to CPS is an attending responsibility. Let the attending decide what to do.

Call the Center for Miracles – they like that child abuse thing.

Two month old babies don’t roll off beds! I’m reporting to CPS