Doin’ the tack shed blues

Authors: Lou Mitchell, Steve Fordham / Editor: Clifford J Mann / Reviewer: Peter Kilgour, Lou Mitchell / Codes: PMP4, PAP12 / Published: 29/04/2023

A 4-year-old boy is brought to your Emergency Department (ED) by his parents one evening. Two hours previously he had been on the back of a horse being led from the field to the tack room before going out for a ride. The horse was unsaddled and he was not wearing his riding hat. The horse bucked and his Dad witnessed him “somersault in the air and then land on the ground head first.”

He was very briefly knocked out, and since the fall had been quiet but otherwise OK in himself. He said his head hurt a bit, but he was eating crisps and was actively exploring the triage room. He had no significant amnesia and had no vomiting.

You examine him and find a moderate haematoma on the right scalp above his ear, and a black eye developing. He is tender over his right zygoma. His primary survey reveals stable ABC, with GCS is 15/15 and and unremarkable neurological exam.

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