what would you do pt. 2

It's hurricane season here in Fiji so it rains every other day and when it rains it pours!  On the plus side the temp is significantly cooler when it rains so it makes not having AC *almost* bearable.

Here's a case I managed where my plan was vastly different from what is done here in Fiji.

40 yo M involved in auto vs. ped at <10 mph, hit on left side of body and fell down hitting left side of face.  He denies LOC and his only complaint is of left sided facial pain.  He was ambulatory after the accident and walks into the ED without any problems.  On exam, VS are within normal limits, pupils equal and reactive, he has a 3 cm superficial laceration lateral to his left eyebrow and some swelling over his nasal bridge, neck is non-tender midline with full active range of motion.  There are no external signs of trauma on his chest, abdomen, or extremities.  Chest is clear and non-tender and abdomen is soft and non-tender.  Pt is alert and oriented with GCS 15.

What would you have done with him?  I wanted get some x-rays and send him home...

Well, here is what was done according to Fijian practice:

1. Patient placed in c-collar

2. Started IVF bolus and oxygen by mask

3. skull XR, chest XR, c-spine XR, and abdominal U/S - significant only for old nasal bone fx

4. Admitted to surgical service for 24 hour neuro status observation