In anticipation of episode 25 on syncopy in both pediatrics and adult patients, we have

with us Dr. Anna Jarvis, who has practiced pediatric emergency medicine for some 40 odd years,

who's going to tell us about her best case ever related to pediatric syncope.

Dr. Jarvis, let it read.

Well, when I was asked to do my best case, I said I had to share two because these two

have never left me.

I think we learn best when we miss something or something sneaks up on us and takes

us by surprise. So the first one was a 10-year-old boy who came in following a fall from his bicycle.

For some reason, it was assumed at the triage desk. His only problem was his elbow.

And indeed, he had an extremely deformed supercondular fracture of his elbow, which needed hails and plates.

He arrived at the hospital with his teacher, as he'd fallen at school.

He started his mantra of, I hate needles.

I don't like them.

I don't give me a needle.

I won't stay if you give me a needle.

So we concentrated on being nice

people and child-friendly and a very senior empathetic nurse took himself and his mother on a tour

of the sedation area to show him how harmless it was and how the monitor is interesting and he could watch his

heartbeat and oxygen saturation during the procedure. During this, he faints flat on the ground,

hitting his head on the tile floor. What do you think was the cause of the problem?

It wasn't situational vo-vegal attack.

This young man had ruptured his spleen.

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