CASE:

This is a 2 year old who was run over by a truck. A heavy delivery truck was driving forward slowly in a delivery service area. This 2 year old child dashed out in front of the truck. She fell forward as she was struck by the bumper. The front tire rolled over her body prone on the pavement from the buttocks toward her left shoulder. She was crying and her parents who noticed what happened immediately carried her into their car and they drove to the hospital.

Examination:

VS T37, P140, R40, BP 100/65, oxygen saturation 94% in room air. She is crying, alert and co-operative. She follows commands well. Her head shows no tenderness, bruising or abrasions. Pupils are reactive. Vitreous is clear bilaterally. No facial abrasions or bruises. TM's are normal. Teeth are intact without evidence of oral injury. Her neck is non-tender. Her neck range of motion is not restricted since she was carried in by her mother without any previous immobilization. Heart regular. Lungs clear, but she has an occasional grunting character to her breathing. Her oxygen saturation rises to 100% when placed on oxygen by mask. Her anterior chest shows no bruises. Her abdomen is soft with active bowel sounds. No definite tenderness is present. There is extensive bruising over her anterior pelvis. There is no bleeding. Her labia are bruised but no bleeding or tears are noted. Her upper extremities are non-tender and her lower extremities are non-tender distal to the pelvis. Her back shows mild bruising in the upper chest and the buttocks. She can move all her fingers and toes well. She does not move her lower extremities spontaneously. There are no extremity deformities noted. Her color and perfusion are good.

Her airway and breathing are assessed as being satisfactory at this time with the oxygen by mask. An IV is started and laboratory studies are ordered. Her circulatory status is assessed as being satisfactory at this time. Portable radiographs of her neck, chest, abdomen and pelvis are obtained.

View her neck radiographs (below)

Her lateral neck radiograph is normal although C7 is not visible. Her neck is non-tender and her range of motion is good so no further neck radiographs are ordered. An AP view of her chest obtained in the supine position does not identify any fractures of the clavicles or ribs.

View her chest radiographs (below)

View her abdominal radiographs (below)

View her pelvis radiographs (below)

What is the diagnosis?

Last created on 01-07-2006