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My colleagues in the ER so often amaze me. I have immense respect and admiration for how they manage such a challenging task. Every day can bring catastrophe–or several–that can be heartbreaking or terrifying, and they face this while addressing a veritable flood of minor or chronic problems which, by training, are more outside their domain. Yet there they are, juggling those diverse situations with such grace, compassion, and skill.

Not to sound critical, but as a primary caregiver there are circumstances when a cautious and deliberate approach may be preferable, but that can be immensely difficult in the ER where by necessity the focus must be on NOW. That fraught difference may best be illustrated in the approach to CT imaging. All good docs in and out of the ER nowadays try to keep in mind the risks of exposure to ionizing radiation. People are subject to small amounts of radiation normally every day. A typical chest xray exposes one to 10 days and a CT scan to a whopping 8 months worth(that, itself, represents improvement in technology–it used to be 5x that amount)

Now, in many instances–and especially in the ER–the information obtained from CT scan is absolutely essential to make an accurate diagnosis and protect the patient. But the reality is that we know that radiation exposure increases the risk of cancer. We know the effect is cumulative and therefore greater for children. But we really don’t know HOW MUCH is a risk–where is the threshold?

So there is reason for caution but certainly not for panic. For example, in one specific instance–head trauma–CT scans are indicated if there was loss of consciousness, amnesia, severe or worsening headache, vomiting, of if the person was drinking when they were injured. Outside of those situations, CT is unlikely to add useful information.

Generally speaking, when confronted with these choices in the ER (or anywhere) keep these principles in mind:

  • As a parent or caregiver you always have a choice. It is important that you have all the information
  • Is there a clear medical benefit for conducting a CT scan
  • Are there other tests (such as an MRI or ultrasound) or actions (such as observation) that could safely take the place of the CT
  • If a CT is indicated, ask to make sure that the scan settings are adjusted to the size and weight of your child
  • Explain to your child that the scanner looks like a donut, they should lay flat and still, and that the test will be quick and will not hurt. Sedation may be necessary for that purpose.
  • Avoid multiple scans. Note the number of scans. Keep my office informed so that we can track the total over time.

Remember that in the large majority of these situations the ER doctor is an experienced expert who is focused on what is best for your child and usually his advise is your best bet. But also remember that the ER doc should listen to you, too. In the unlikely event that you are unclear on that side of it, call–let me help to clarify the situation for you and to advocate on your behalf there. That’s my job.

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