Hot Seat #146 DenouementPosted on: March 5, 2020, by : Brian Lee
Case review: 3yoM, otherwise healthy, who presented with a large facial laceration ultimately found to have a glabellar fracture.
Here’s how you answered:
Discussion: The case led to a lively discussion about several points in the management. In terms of initial evaluation, the room was pretty split on whether to get maxillofacial CT alone or also with head CT. Dr. Shaukat mentioned that most times radiology can construct the images from the maxillofacial CT (thus “obtaining” at head CT) to spare some radiation. In terms of antibiotics, the room was somewhat split in how to best deal with this issue and apparent discrepancy. On the one hand, some felt that clarifying with neurosurgery might clear up some of the confusion, while others suggested reaching out to another specialist (plastic surgery) in order to weight in, while still others stated that they would use their own clinical judgement to determine whether antibiotics were or were not indicated.
Denouement: Following follow-up discussion with neurosurgery, ED trauma tech, decision was made to close in the ED. Wound was well approximated, and the child was discharged home with close follow-up. On repeat exam, wound well healing without any evidence of infection.
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