Sample Transcribed Reports:

Diagnoses: Maxillary sinusitis; Cerebral Abscess

I was asked to accompany this 6½ -year-old girl in transport from * * * * * to * * * * * General Hospital after she recently underwent investigation and therapy for a fever, headache, and nausea and vomiting that followed an upper respiratory tract infection.

Initially, this patient was found to have a right maxillary sinusitis and was treated with oral antibiotics. However, she became more ill and was admitted to * * * * * Hospital where a CT scan of the head revealed a left frontal cerebral abscess with epidural abscess. The patient underwent craniotomy for drainage of epidural abscess by the neurosurgeon and drainage of her right maxillary sinus by the otolaryngologist.

She received a prolonged course of intravenous and broad-spectrum antibiotics postoperatively.

Diagnoses: Cervical Central Spinal Cord Syndrome and Epidural hematoma; Child Abuse

I was paged in order to assess, stabilize, and prepare this 23-month-old boy for transport to the Intensive Care Unit at * * * * *.

This patient was brought to the Emergency Department in * * * * * General Hospital on ***** after an unwitnessed fall of a low height onto a carpeted floor at home. The mother brought the child to the Emergency Department for suspected injury of his right arm.

When examined by the Emergency physician, the patient was noted to have an abnormal pattern of bruising on his head and trunk and there was some suspicion of non-accidental trauma. A skeletal survey was undertaken, but no fractures were identified and the child was referred to the pediatrician on-call. The child was ultimately discharged home from the Emergency Department after a period of observation and recovery of normal arm function.

The patient was brought back to hospital the next afternoon after the mother reported a progressive weakness involving the arms and subsequently the legs over the next day. The child initially was unable to lift a bottle to his mouth without assistance and later was noted to have a wobbly gait after his nap.

Re-evaluation by the pediatrician revealed a flaccid and areflexic paralysis of the upper limbs and motor activity was restricted to a minimal flexion of the fingers. Although power of the lower limbs was reduced, the child was still able to kick. Deep tendon reflexes were difficult to elicit.

A number of laboratory investigations were undertaken and the only abnormality was a leukocytosis on the CBC accompanied by a thrombocytosis. A computed tomography scan of the head was also normal.

Treatment with high-dose intravenous glucocorticoids was undertaken for suspected spinal cord injury according to the spinal cord protocol at * * * * * Hospital.

A complete physical examination, as well as review of all available laboratory investigations and x-rays was performed by myself when I arrived in the Intensive Care Unit in the * * * * * General Hospital.The major findings were those of an extremely irritable and pale boy who had multiple ecchymosis on his head and neck at different stages of resolution. The child was able to rotate his neck, but not flex or extend there. He also could not shrug his shoulders. The only motor activity in the upper limbs was restricted to the distal interphalangeal joints of the hands. Power in the legs was diminished, but the child was able to kick.

My concern was that this child may have developed either a transverse myelitis, epidural hematoma, central cord syndrome or epidural abscess.

The child was transferred via aircraft to * * * * * and then via ambulance to * * * * * where he underwent urgent Magnetic Resonance Imaging of his spine, spinal cord and neurosurgical consultation.