Case by Jasmine Thomas MD, CNMC PEM Fellow

A 2-year-old male presents with his father after a fall that occurred while playing. The patient’s father was throwing him in the air when he slipped from his hands, falling face forward approximately 5 feet onto the concrete ground. No reported loss of consciousness or vomiting. He presented one hour later to the ED.

The patient is triaged as a level 4 and seated in the D-side hallway

VS: T 36.5 C Pulse 108 bpm Respiratory Rate 20 br/min  BP 105/59 mmHg SpO2 100 %

General: alert and comfortable in his father’s arms but screams when you get near him. 

HEENT: No palpable scalp hematomas or bogginess, no facial lacerations, no facial tenderness, no hemotympanum or otorrhea, PERRLA, no blood in nares, no nasal bridge tenderness/misalignment, + intrusion of central upper incisors, No jaw tenderness or unwillingness to open mouth.

Neck: Normal ROM. No reproducible cervical neck tenderness

Cardiac: Regular rate and rhythm

Lungs: Lungs CTAB, no diminished breath sounds 

Abdomen: BS active, no tenderness to palpation  

MSK: Moving all extremities, no obvious deformity 

Head CT obtained is without intracranial abnormalities, however, the radiologist calls with recommendations to obtain dedicated CT max/face as there is a partially visualized mandibular condyle fracture.

You obtain trauma labs. Mandibular fracture confirmed on CT max/face.  OMFS and dental have been called for injuries. 

Meanwhile, the patient’s mother is now at the bedside and both parents begin to argue and throw objects at one another. The patient’s mother accuses the patient’s father of purposefully injuring the child, and at that point, security separates the parents.