In anticipation of our main episode podcast on pediatric physical abuse, I'm thrilled to have with us, Dr. Carmen Coombs, pediatric emergency physician, double credentialed in both pediatric EM and child advocacy. That's their child abuse team at Children's Hospital in Pittsburgh.

Dr. Coombs, welcome to EM cases, and let's hear your best case ever.

Thank you, Anton.

This is a case that I saw many years ago early in my training at Janice Hospital.

This was an 18-month male who presented to our hospital after being found unresponsive at home.

The story was that he had been at home during the day with mom's boyfriend while she was out doing errands.

He was in the kitchen, cooking dinner. The child was sleeping in the nearby living room.

The boyfriend reported that he woke up, He needed his diaper change. He changed his diaper. He laid him back down on the couch and then he went back into the kitchen to finish making dinner. He was only gone for a few minutes, but when he came back, he found him still laying on the couch, purple and responsive and not breathing. He tried to revive

him. He describes splashing water in his face, taking him upstairs, putting him in the shower.

But when the child still failed to respond, he started CPR and called 911. The ambulance arrived.

They found a child in a full arrest. They continued CPR. They placed an I.O. They gave him EPI. And they actually were able to achieve return of spontaneous circulation. When he presented to our emergency department, we intubated him. And his evaluation was most notable for a large subdural hemorrhage

with midline shift on his CT of his head, and his CT of his abdomen showed a liver

laceration and a duodenal hematoma. So this is pretty much a slam dunk for this child being a victim of physical abuse.

So this is obviously a very upsetting, difficult situation. What happened from there?

So he was admitted to R. Pick you. He had an EBD placed and then eventually went on to have a burhole and a ventricular drain. He was very sick. He was on

multiple pressers. He required blood products to help support him because of the liver laceration.

He was intubated for prolonged time. He had seizures. We did do an opso exam, which also found

that he had extensive bilateral retinal hemorrhages. A G-tube was placed. He had

extensive inpatient and then later on outpatient physical therapy, occupational therapy, and

speech therapy. My understanding is that a lot of these cases of physical abuse, that there's

antecedent abuse before sort of the big bad

abuse gets discovered. Was there any clues in this child's history from previous visits, for

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