A 9-year-old boy is brought to the emergency department by his aunt with right arm pain and swelling after falling in his backyard. The aunt says that the boy fell off the monkey bars and landed on his right hand. There was no head injury or vomiting. On physical examination, the child screams in pain and feels tingling in his right fifth digit. The right elbow is swollen and deformed. The right radial pulse is 1+ and sensation is intact. Radiographs are obtained. The boy's aunt is not his legal guardian but would like him to be treated for this injury. His parents are currently out of town and cannot be reached by phone. The aunt mentions that the boy was treated at this hospital 3 months ago and his mother gave consent for treatment at that time. Which of the following is the most appropriate next step in the management of this patient?

Question

A 9-year-old boy is brought to the emergency department by his aunt with right arm pain and swelling after falling in his backyard.  The aunt says that the boy fell off the monkey bars and landed on his right hand.  There was no head injury or vomiting.  On physical examination, the child screams in pain and feels tingling in his right fifth digit.  The right elbow is swollen and deformed.  The right radial pulse is 1+ and sensation is intact.  Radiographs are obtained.  The boy's aunt is not his legal guardian but would like him to be treated for this injury.  His parents are currently out of town and cannot be reached by phone.  The aunt mentions that the boy was treated at this hospital 3 months ago and his mother gave consent for treatment at that time.  Which of the following is the most appropriate next step in the management of this patient?

Quizplus · Accepted Answer

Explanation: 11ec2b69_c0d3_f708_8f63_416d5de3c3ca_MD0005_00 Consent for treatment of minors should be obtained from either a parent or legal guardian; exceptions include specific medical circumstances or emancipated minors (Table). The criteria for medical emancipation vary by state but generally apply to minors with children, those who have served in the military, those who are or have been married, and those living away from home without parental financial support. Although this child does not meet criteria for emancipation, he should be treated regardless of parental consent as he is presenting with a medical emergency and delaying treatment could harm his health. The patient has a type III supracondylar fracture with possible neurovascular compromise based on the presence of a diminished radial pulse and paresthesias. Delaying treatment due to lack of parental consent (Choice A) is inappropriate as the pain is severe and there is high risk of injury-related complications. The parents should be notified as soon as possible after timely treatment is provided. type III supracondylar fracture neurovascular compromise (Choice B) Fractures that are highly suggestive of non-accidental trauma include rib fractures, metaphyseal corner fractures, and multiple fractures in various stages of healing. This patient's supracondylar fracture is consistent with the reported mechanism; child abuse is unlikely. In addition, parents are generally not allowed to refuse medical investigation when child abuse is suspected. (Choice D) The aunt cannot consent to treatment unless she is the boy's legal guardian. (Choice E) Although extended consent can be obtained in certain circumstances (eg, blood transfusions in oncology patients), consent for treatment is generally obtained for each new medical encounter and procedure. Previous parental consent does not guarantee consent during a new encounter. Educational objective: Consent for treatment is generally obtained from a parent or legal guardian prior to initiating medical treatment for a minor except in specific circumstances. These circumstances include emergency care, sexually transmitted infections, and emancipated minors. References: Consent for emergency medical services for children and adolescents. (http://www.ncbi.nlm.nih.gov/pubmed/12612264)

A 9-Year-Old Boy Is Brought to the Emergency Department by His