I had seen this 4 years girl 2 weeks ago. She had presented with vomiting x1 and quite sleepy after a fall incident. She had fallen from a table while playing. No sign of concussion noted but I had always be cautious with kids. I offered a brain CT and the parent gave me a green light. Nothing was notable on the scan but pending to her sleepiness, I had admitted her. She was discharged a few days later.
During my last call, the mother had brought the girl to me again. She said, “ she did not get better, you see, her head had swollen again.” She had shown me that big bum over the girls’ left parietal scalp. It was a true bum. I always took such accusation seriously any misspoken word or question might end up a legal suit. I did a very cautious history taking.
1. When was the bum noted – yesterday night
2. Was it so “big” when it was noticed ?
Nope – it was small initially ..
3. Did she have a fall ?
Nope – she did not sustained any fall
4. Was she within you eyesight all the time ?\
Nope, I went to work and the granny look after her…
5. So how can you sure, she did not fall when you are not around ?
She did not tell me so I presume she did not have a fall…
Well…5 questions lead me to answer : negligence. I told the parents (tolerating their alcohol scent breath..) that definitely a new lesion – the brain CT was ok during her last admission…
I unwilling ordered another scan ( the bum was big…so big that I could not feel the skull bone)
The scan result had made me to call up X (our neuro-surgeon). She had had left parietal subdural hematoma ( small one <2cc). X came down personally and gave the parent a very serious bombardment about child caring…The child was admitted to ICU later…. I had to rearrange the bed so that I could clear a separate cubicle for the child…..
Well, kids were so fragile – I quote what X said that day – “fall and fall, made you child stupid…” parents please please take a good care of them....
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