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Focus: Craniofacial Structures and the Integumentary System

Patient Update

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Clay Davis is a 7-year-old child who is being treated at Okla Trauma Center for severe injuries received in a motor vehicle accident this afternoon. Clay was apparently sitting in the backseat of the car when the accident occurred. The EMT reports that the child did not have a seatbelt on and that Clay appears to have hit the back upper edge of the front seat with his jaw. ABCs were done on the scene and in the ambulance on the way to Okla Trauma.

At the time of the incident, Clay was in the company of his grandparents, Zane and Stevie-Rose Davis. He had no identification on him, and, although his grandfather is also being treated at this facility, the staff has not yet made the connection. The paramedic who brought the child in gave the staff the patient's name; he told the staff that he got the information from another EMT on the scene, who was attending to the child's grandmother.

 

"I'm Dr. Lincoln from Peds. What have we got here?" asked the physician as he entered the ER bay. He noted that the team was busily involved with patient care, and he watched for a moment as a nurse gently removed the child's oxygen mask while being careful not to jostle the child's head or neck. The patient's mouth was bloody and swollen. Nasal prongs were quickly placed. The child's head was still in the spinal fixation collar from Emergency Services.

"Suction standing by," interjected one of the nurses as the staff continued their work. The child moaned loudly, tried to move, and tried to push away the helping hands.

The ER physician, Dr. Raymond, was talking to the boy. "It's all right, son. I know you're in a lot of pain. You've been in an accident, and we're going to help you now. I'm Dr. Raymond. I have to get a look at your face." He paused a moment then to turn to the newly arrived pediatrician, Dr. Lincoln. "Good to have you here, Steve," Dr. Raymond said. "We've got a 7-year-old male, blunt force trauma to the face. I've just started the assessment, but feel free to take over if you like. Kids are your specialty."

"Thanks. I got your page and came as quick as I could," replied Dr. Lincoln. "Let's see what we can do together. You'll stay?" Dr. Raymond nodded in agreement.

"Right, well, first things first. I see he's breathing on his own, but with that trauma to his mouth and a burn across his upper torso … well, this could soon be compromised. What are his 02SATS, nurse?" Dr. Lincoln asked.

"95%, doctor."

"Okay. This facial trauma comes first, before what appears to be a partial-thickness scald burn on his torso. I'm worried about the lower jaw. Have you taken a look at his spine, Dr. Raymond?"

"No, not yet," said ...

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