A fatal case of Perthes syndrome

Prevalence and Causes of Subconjunctival Hemorrhage in Children

OBJECTIVE

Subconjunctival hemorrhage (SCH) is a reported sign of occult abusive injury, but there are limited published data about SCH during childhood. We sought to determine the prevalence and causes of SCH in children.

METHODS

This is a retrospective cross-sectional study of children seen by pediatric ophthalmologists in an outpatient setting over 4 years. Primary outcomes were prevalence and causes of SCH, based on history, physical ocular and nonocular findings, and laboratory and imaging studies. Subconjunctival hemorrhage prevalence was determined including and excluding eye surgery to reduce bias in the prevalence estimate.

RESULTS

We studied 33,990 children, who underwent 86,277 examinations (median age, 5 years; range, 2 days to 18 years; 9282 younger than 2 years, 13,447 age 2-7 years, 11,261 age 8-18 years). There were 949 cases of SCH (1.1%; 95% confidence interval, 1.0-1.2). When surgery was excluded, there were 313 cases (prevalence, 0.4%; 95% confidence interval, 0.3-0.4), of which 261 (83%) were due to trauma; 40 (13%) ocular surface inflammation, including infectious conjunctivitis; 7 (2%) orbital or conjunctival lesion; 3 (1%) vessel rupture from choking or cough; and 2 (1%) coagulopathy related. Across all ages, including less than 2 years, trauma and inflammation together accounted for 94% to 97% of all cases of SCH.

CONCLUSIONS

Subconjunctival hemorrhage is uncommon in children. The great majority of cases are due to trauma. All children with SCH, including infants and young children, should be closely examined to identify other ocular or nonocular signs of trauma.

Prehospital recognition of life-threating thoracic trauma

Introduction: Severe thoracic trauma is a potentially lifethreatening injury, leading to immediate impairment of cardiorespiratory functions or bleeding; but also consequential fatal infections, damage of: heart, large blood vessels, mediastinal organs or pleura with pneumothorax/hematothorax. Objective: To present a case of penetrating chest injuries with forks, caused by traffic. Methodology: Case report from medical documentation. Case report: The EMS team was called for a car accident including vehicle and a tractor. At the passenger seat of the car, a female person was found stabbed with a pitchfork through the torso and fixed to the seat. Firefighters cut a part of the metal forks, while medics stabilized foreign body and made emporary hemostasis. The entrance and exit wounds were verified. Vitals were: TA: 130/60mmHg, heart rate 100/min, SaO2 90%. The peripheral venous line was opened and O2 10L/min was applied through an oxygen mask. The patient was transported in a sitting position, with medical manual stabilization, to the ER. The surgeon was immediately consulted and the patient, due to vital indications, was urgently admitted to the operating room. In the abdomen, 8 cm laceration of the III segment of the liver, cleft omentum and deserosion of the small curve of the stomach were verified. A foreign body passed between the aorta and the esophagus, without injuring them. Conclusion: Thanks to the prompt EMS reaction and the proper pre-hospital care, as well as early inpatient surgical treatment, the patient's outcome was good.

[Perthes syndrome secondary to an asthma attack: A case report in a 15-year-old child]

Perthes syndrome, or traumatic asphyxia syndrome, is a rare clinical entity, associating cyanosis, cervicofacial petechiae and subconjunctival hemorrhage. It is usually secondary to chest trauma, but can occur in any situation of abrupt rise in intrathoracic pressure with closed glottis. In this paper, we present a case of Perthes syndrome that triggered an asthma attack for a child during surgery.

Traumatic asphyxia--fatal accident in an automatic revolving door

Due to continuing modernisation, the number of automatic doors in routine use, including powered revolving doors, has increased in recent years. Automatic revolving doors are found mostly in department stores, airports, railway stations and hospitals. Although safety arrangements and guidelines concerning the installation of automatic doors are in existence, their disregard in conjunction with obsolete or incorrect installation can lead to fatal accidents. In this report, a 19-month-old boy is described whose right arm was caught between the elements of an automatic revolving door. As a direct result of rescue attempts, the child's body was drawn further into the narrow gap between elements of the door. To get the boy's body out of the 4-cm-wide gap between the fixed outer wall of the revolving door and the revolving inner, back-up batteries had to be disconnected so as to stop the electrical motor powering the door. Cardiopulmonary resuscitation was begun immediately after the rescue but was unsuccessful; the child was declared dead at the hospital he was taken to. The cause of death was a combination of compression-related skull and brain injury together with thoracic compression. This case shows an outstanding example of the preventive aspect as a special task of forensic medicine. Additionally, it serves as a warning for the correct installation and use of automatic revolving doors. Even so, small children should not use these doors on their own, but only with an alert companion, so as to prevent further fatal accidents of this sort.