Child abuse: discovering the horrifying truth

Abstract

EMS is called to the residence of a 2-month-old child who's lethargic and has not eaten well for several days. On arrival, the grandmother of the patient states she's concerned because the child isn't acting right. During your assessment, you notice the child isn't acting age appropriate. Initial vital signs after placing the patient in the ambulance reveal: blood pressure 82/46, pulse 146 bpm, respirations 32 and a blood-glucose level of 134 mg/dL. Further assessment reveals bruising to the pinna of the right ear. On arrival at the emergency department (ED), the child begins to have periods of apnea, and the hospital healthcare providers intubate the patient. A post-intubation chest X-ray reveals multiple acute and sub-acute rib fractures. The ED staff exposed the patient during their assessment and noted bruising to the left ear and the jaw. There's also bruising found in different stages of healing to the anterior and posterior chest wall. The ED staff suspects this patient is a victim of child maltreatment, so the proper authorities are notified. During the investigation, the mother admits to abusing the child.