Case Presentation

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Case Presentation 19

• Jim Pointer, M.D., FACEP
• Medical Director
• Alameda County EMS

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The Call

• You respond to a 9-1-1 call on a busy suburban
  street for traumatic injury. Your patient, a
  seven year-old male, is lying prone on the street
  with his head nodding in confusion. An electric
  microscooter lies on its side in the middle of
  the street.

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Initial Assessment

• ABCs
• Airway open
• Breathing labored
• Circulation no bleeding
• Glasgow - 9
• Eyes 2
• Verbal 3
• Motor 4

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Focused H P

• On lookers state the patient attempted to avoid a
  car, swerved and fell, striking his head and
  legs.
• Child was wearing no safety equipment and was
  traveling about 10 mph on the wrong side of the
  street.
• No other history available and the parents are at
  work.

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Pertinent Findings

• Vital Signs
• B/P 80/50
• RR 32
• HR 145
• Pulse Ox 96
• Young male obviously seriously injured

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Pertinent Findings (cont.)

• HEENT
• Head large abrasion left fronto-temporal area
• Ears no blood from ears
• Eyes pupils 4 mm, slightly sluggish, reactive
• Nose WNL
• Teeth WNL
• Neck no obvious injuries, unable to assess pain
  or tenderness

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Pertinent Findings (cont.)

• Chest and abdomen no significant trauma
• Pelvis stable
• Extremities deformity left lower leg, distal
  pulses intact
• Neuro GCS 9
• Patient does not answer questions but is seen to
  move all four extremities
• Skin cool and moist

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Initial Treatment

• Attempts at intubation unsuccessful
• Non-rebreather mask - 100 O2
• Two large bore IVs started
• Spinal immobilization
• Left lower leg splinted
• Transported to Childrens Hospital

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(No Transcript)
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Hospital Findings

• Young, white male in acute distress
• Vital signs B/P 120/82, RR 40, HR 142,
  Pulse Ox 98 on O2
• Physical findings essential the same as yours

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Lab Studies

• CBC WBC 17.2 K, H H 15.3 / 47.2
• Chemistries, glucose, urinalysis WNL
• X-rays Spinal, chest, pelvic and Left lower leg
• Plain CT of the head
• Hospital staff can not find the parents

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CT Scan
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Extremity X-Ray
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Hospital Outcome

• Patient taken to OR for evacuation of subdural
  hematoma
• Open reduction, internal fixation (ORIF) of the
  tibial fracture
• Discharged eight days later on crutches with
  case, neurologically intact!

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Addendum

• Parents were cited by local police for allowing a
  child under 16 to operate a motorized scooter and
  for failure to provide safety equipment.

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Discussion

• Skateboard and scooter injuries
• Skateboards
• 56,000 ED visits
• 1,900 hospitalized
• Scooters (all)
• 15,800 ED visits
• 90 of all injuries occur in kids lt 15 years old.
• Source American Academy of Pediatrics

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Skateboard Injuries

• 87 - male
• Distribution of Injuries
• 74 - extremities
• 21 - head neck
• 5 - trunk
• Injuries occur more frequently in the younger
  child
• Source US Consumer Product Safety Committee

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Skateboard Injuries (cont.)

• Most common Injuries
• Wrist fractures
• Ankle sprains
• Face lacerations
• Lower arm fractures
• Wrist sprains
• Source US Consumer Product Safety Committee

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Motorized Scooters

• Rising in popularity
• Gasoline or battery powered
• Cost 200 - 1500
• Cost of protective gear 35
• Gas models against the law in many jurisdictions
• Many areas have restrictions
• Californias age is 16
• US CPSC issued warning in 2001
• Parents poor judgment a major factor in injuries.

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Motorized Scooter Injuries

• 39 are kids lt 15 years old
• At least three deaths associated with motorized
  scooters
• 6 year old boy who fell off
• 11 year old boy who crashed with a truck
• 46 year old man who was struck by a car
• Fractures the most common injury
• Over 5000 injuries requiring ED treatment in 2002

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SCOOTER SAFETY
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Injury PreventionSkateboards Scooters

• Never ride in the street
• Never ride at night
• Obey all traffic laws

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Injury Prevention (cont.)

• Dont take chances
• Complicated tricks require careful
  practice and a specially designed area
• Only one person per skateboard
• Never hitch a ride from a
  car, bus, truck or bicycle

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Injury Prevention (cont.)

• Learn how to fall it may help reduce serious
  injury
• Losing balance crouch down so you wont have as
  far to fall
• If you fall
• try to land on fleshy parts of your body
• try to roll rather than absorb the force with
  your arms
• try to relax your body rather than stiffen

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Injury Prevention (cont.)

• Use Safety equipment!
• helmet
• Slip resistant shoes
• Padding (knee, elbow and wrist guards)
• Children lt 5 should not use skateboards or
  scooters
• Children lt 16 should not ride
  motorized scooters

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California Law

• January 1, 2000
• Children under 16 prohibited from operating
  motorized vehicles, including scooters, and
  requiring helmet.
• January 1, 2003
• Bicycle helmet law expanded to require children
  under 18 to wear safety equipment when riding
  scooters, skateboards or skating

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EMS Helmet Bicycle Safety Brochure