Case #64 "Stuck On You!"
by Charlene Babcock Irvin, MD, FACEP
A
22 month old male presents after hitting his
head on the fireplace. He has a laceration
on his forehead. Grandma was watching him,
and he was simply running and not watching
where he was going, tripped and fell into
the fireplace edge (marble) and struck his
forehead. He had no loss of consciousness
(LOC) and cried immediately. There has been
no vomiting, drowsiness, or change in mental
status. The father brought him in to be sure
he didn’t have a concussion, and to have his
laceration repaired.
PE: BP 115/80, RR = 20, Pulse = 115, Sat =
99%, Temp: 98F
HEENT: 1.5 cm laceration to forehead, into
subcutaneous fat, no bone exposed, no scalp
fracture visible or palpable, no hematoma.
TM nl, PERRR, neck supple, full range of
motion, no tenderness to palpation.
Oropharynx normal.
Heart RRR, normal
Lungs= BS, normal
Abd: Soft NT, no contusions. Normal
Ext. Normal
Neuro: Alert, follows commands from dad.
Cranial nerves grossly in tact. Motor normal
in all four extremities. Balance and gait
are normal. Sensation and reflex’s normal.
You inform the dad that the child looks
fine, but will need the wound repaired. You
suggest tissue adhesive to close the wound.
The dad has a few questions.
1. Isn’t suture better? Won’t stitches leave
a smaller scar?
2. Besides glue (tissue adhesive) and
stitches, what are the other alternatives?
3. Shouldn’t his baby get a CT scan to be
sure there is no head injury?
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