QuestionSBA
QuestionChoice
This is well-meaning but premature, a senior with experience needs to be involved in the case first.
10034935
d
Call the police
QuestionChoice
This is inappropriate given the safeguarding concerns in this case.
10034933
b
Discharge with analgesia and safety netting
QuestionChoice
At present, there are no specific concerns with the upper limb warranting radiation exposure. A full non-accidental injury workup may be performed which includes a skeletal survey, photography and possible ophthalmology review for retinal haemorrhages.
10034934
c
Refer for upper limb X-ray
QuestionChoice
There are no concerns over the upper limb that warrant orthopaedic review.
10034936
e
Refer to orthopaedics
QuestionChoice
This is correct. This scenario is concerning due to the delay in presentation to the ED and the mechanism of injury not being possible in a two-year-old (riding a tricycle is a skill expected in a three-year-old). Therefore, this child should be admitted and discussed with the local safeguarding lead/consultant paediatrician on-call due to possible non-accidental injury.
10034932
a
Admit for observations and safeguarding review
QuestionComment
A single-day delay isn't that concerning, most parents don't want to put their child through an A&E attendance unless they think it's really necessary... so often they wait to see if it gets better and will bring them in the next day. Also, milestones are AVERAGES, some 2 year olds will already be riding a normal bike, so riding a tricycle isn't unheard of. Obviously pay attention to these things, like if the proposed mechanism of injury makes sense, but also think a bit.
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Amnesia Defibrillator
QuestionComment
not being possible in a two-year-old made me laugh
61952
User
subscriber
Defibrillator Dominant
Concept
Chapter
2693
6105
Non Accidental Injury
Topic
153
Paediatrics
19390
When non-accidental injury is suspected, admission for observation allows monitoring of the child's condition. A safeguarding review ensures the child's safety, with a thorough assessment by social services and medical professionals.
A two-year-old boy is brought to the emergency department with pain in his arm. His mother reports he was injured falling off his tricycle yesterday. Neurovascular assessment of the upper limb is unremarkable.

Which of the following is the most appropriate next step?
a