Morning Report

teaching_rounds

 
Morning Report is a case-based teaching tool typically done at the start or end of a shift, or during dedicated teaching time on the wards. Traditionally done in person with the line of questioning from faculty used to discern the breadth and depth of knowledge of the residents’ and medical students’ present, we are going to try to capture some of that style here with these cases. So to get the most out of the cases below don’t skip ahead or click to reveal the answers without giving yourself time to formulate an answer.

 
Well, yes, many of the events that bring pediatric patients to the Emergency Department could be due to child abuse or neglect. In fact, the American Academy of Pediatrics just recently published a new Clinical Report, The Evaluation of Suspected Child Physical Abuse. The main focus of this publication is that physical abuse is terrifyingly common across all socio-economic groups, under-diagnosed, and associated with significant long-term medical, psychological, and social harm.
 
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34 year-old male self-presents to the Emergency Department after being hit in the abdomen with a baseball bat 3 hours before while walking too close to the on-deck circle at his son’s high school baseball game.
 

Figure 1: Parietal swelling with bruising after motor vehicle accident. courtesy of Agarwal N, Kumar S, Joshi MK, Sharma MS, via OPENi.

 
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Two very concerned parents bring their two-year old son into the Emergency Department after they heard a thud.
 

 
“I was watching him sitting on the couch while I was folding clothes. I turned around to put the laundry basket away, and the next thing I know, I hear a loud crash, and little Timmy is face-down on the hardwood floor crying,” said the father sheepishly.
 
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Platypus identical triplets, Huey, Dewey, and Louie, walk into a bar and proceed to start a riot over whether or not they are mammals given that platypodes lay eggs. 911 is called. The three are brought to the ER for injuries sustained above the clavicles defending the honor of their species:
 
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Triage Summary: 45 year-old Mountie is brought in by his trusty steed, Horse, after hurting his left knee one-hour ago by jumping down out of the saddle in hot pursuit of a one, Mr. Whiplash.
 

 
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Please be aware that the image associated with this case is graphic based on the nature of this clinical scenario.
 
EMS Patch:“We are 5 minutes out with a 36 year-old male who was cutting a tree branch on a ladder about 6 feet off the ground when the chainsaw kicked back and struck him in the face. We found him on the ground after his wife called 911. He is constantly spitting up blood, is confused, and is trying to get out of the c-collar. Heart rate is 40. Blood Pressure is 110/76. RR 28. Oxygen saturation is 95% and he won’t tolerate any supplemental oxygen. See you in 5.”
 
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EMS Patch: On scene with a 25 year-old male unrestrained driver who just crashed his car into a tree going ~50 mph.
 
EMS cellphone photo of the crash:

 
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