Jeffrey A Brinker, M.D.
- Professor of Medicine
- Joint Appointment in Radiology and Radiological Science
For survival statistics by stage , see Small Cell Lung 5 Cancer Survival Rates , By Stage . Prevention Tobacco 6 American Cancer Society cancer. Although decades have passed since the link between smoking and lung cancers became clear, smoking is still responsible for most lung cancer deaths. Diet, nutrition, and medicines Researchers are looking for ways to use vitamins or medicines to help prevent lung cancer in people at high risk, but so far none have been shown clearly to reduce risk. While any protective effect of fruits and vegetables on lung cancer risk is likely to be much smaller than the increased 7 risk from smoking, following the American Cancer Society Dietary Recommendations (such as staying at a healthy weight and eating a diet high in fruits, vegetables, and whole grains) may still be helpful. Early detection 8 As mentioned in the section Can Small Cell Lung Cancer Be Found Early? For this test, the doctor inserts a bronchoscope through the mouth or nose and into the lungs. The end of the bronchoscope has a special fluorescent light on it, instead of a normal (white) light. The fluorescent light causes abnormal areas in the airways to show up in a different color than healthy parts of the airway. Some of these areas might not be visible under white light, so the color difference can help doctors find these areas sooner. Some cancer centers now use this technique to look for early lung cancers, especially if there are no obvious tumors seen with normal bronchoscopy. It also helps doctors look at some airways that they might not be able to reach with standard bronchoscopy, such as those being blocked by a tumor. For example, it doesn?t show color changes in the airways that might indicate a problem. It also doesn?t let a doctor take samples of suspicious areas like bronchoscopy does. Still, it may be a useful tool in some situations, such as in people who might be too sick to get a standard bronchoscopy. It shows where the tumor is in relation to other structures as a person breathes, as opposed to just giving a 8 American Cancer Society cancer. Radiation therapy 9 Several newer methods for giving radiation therapy have become available in recent years, For example, some newer radiation therapy machines have imaging scanners built into them. This may help deliver the radiation more precisely, which might result in fewer side effects. Chemotherapy 10 Clinical trials are looking at newer chemotherapy drugs and combinations of drugs to determine which are the safest and most effective. This is especially important in patients who are older and have other health problems. Doctors are also searching for better ways to combine chemotherapy with radiation therapy and other treatments. Targeted therapy drugs Researchers are learning more about the inner workings of lung cancer cells that control their growth and spread. They might work in some cases when standard chemo drugs don?t, and they often have different (and less severe) side effects. Many of these treatments are being tested in clinical trials to see if they can help people with lung cancer live longer or relieve their symptoms. In clinical trials, these drugs have been shown to shrink some small cell lung cancers and help some people live longer. Unlike vaccines against infections like measles or mumps, these vaccines are designed to help treat, not prevent, lung cancer. These types of treatments seem to have very limited side effects, so they might be useful in people who can?t tolerate other treatments. Readers must refer directly to ttle 8 of the California Code of Regulatons for details, exceptons, and other requirements that may apply to their operatons. The standard is codifed in title 8 of the California Code of Regulations, section 5199 What is an Aerosol Transmissible Disease under this regulation? Section 5199 defnes an aerosol transmissible disease as a disease for which droplet or airborne precautions are required, as listed in Appendix A, which has been reproduced on the next page. These diseases can be transmitted by infectious particles or droplets through inhalation or direct contact with the mucous membranes of the eyes or respiratory tract the disease-causing aerosols covered by this regulation are pathogens, such as bacteria and viruses. For exposures to such pathogens, both airborne and droplet precautions must be used. Section 5199, Appendix A Aerosol Transmissible Diseases/Pathogens (Mandatory) this appendix contains a list of diseases and pathogens which are to be considered aerosol transmissible pathogens or diseases for the purpose of Section 5199 Employers are required to provide the protections required by Section 5199 according to whether the disease or pathogen requires airborne infection isolation or droplet precautions as indicated by the two lists below Diseases/Pathogens Requiring Airborne Infection Isolation. Aerosolizable spore-containing powder or other substance that is capable of causing serious human disease. Avian infuenza/Avian infuenza A viruses (strains capable of causing serious disease in humans). Varicella disease (chickenpox, shingles)/Varicella zoster and Herpes zoster viruses, disseminated disease in any patient. What employers does the provided in conjunction with health care or public health operations; Aerosol Transmissible Diseases. Public health services, such as communicable disease contact tracing or screening programs regulation cover? What employers are not covered Outpatient Medical Specialty Practices under this regulation? For example, a skilled nursing facility that is licensed under its associated hospital is covered under the full standard Aerosol Transmissible Diseases 7 Written Procedures Written Procedures 2. Source control procedures Referring employers must establish the following Source control procedures minimize the spread of six infection control procedures in writing and make potentially infectious airborne particles and droplets them available to employees at the worksite: from symptomatic individuals (the source).
Hemagglutinin A membrane glycoprotein (550 amino acids) of the influenza virus type A involved in receptor binding and fusion . The name is derived from its capacity to agglutinate red blood cells at neutral pH . There are 15 hemagglutinin (H) subtypes of which only 3 (H1, H2 and H3) are associated with human illness. Hepatitis A A form of viral hepatitis that is known as infectious hepatitis because it can spread through contact with oral secretions or stool or through sexual contact. Liver disease caused by chronic hepatitis B can be fatal due to the development of cirrhosis leading to liver failure and an increased risk of hepatocellular liver cancer. These patients usually develop chronic hepatitis or become asymptomatic carriers of the virus. The surface coat is added on in the cytoplasm and, for unknown reasons, is produced in large quantities. Symptoms of hepatitis C may not manifest until the chronic stage and include jaundice, fatigue, abdominal pain, loss of appetite, intermittent nausea and vomiting. Cirrhosis from hepatitis C is the major condition responsible for the majority of orthotopic liver transplants in the U. Infection with hepatitis C has also been associated with increased risk of primary hepatocellular carcinoma. The virion consists of a nucleocapsid core and two envelope proteins within the lipid bilayer. Hepatitis, Fulminant A rare syndrome usually associated with hepatitis B and, in rare cases, with hepatitis A or E. It is characterized by rapid clinical deterioration and the onset of hepatic encephalopathy. The liver parenchyma undergoes massive necrosis and the organ size decreases significantly. Functional renal failure sometimes occurs; in some cases, coma may develop within hours of onset. Herd Immunity the indirect protection of unvaccinated individuals against a given disease achieved via immunity of a sufficiently large proportion of the surrounding population against the respective pathogen. The virus is spread via sexual contact with an infected individual, exposure to contaminated blood. Examples are hyaline cartilage and hyaline hyphae present in fungus such as Aspergillosis spp. I Immune System An integrated group of various cell types and the soluble molecules they secrete. Immunization the means to produce a protective immune response in susceptible individuals by administration of a living modified agent. Immunization, Active the means by which antibody production or cell-mediated immunity is stimulated by giving the antigen in the form of a vaccine or through exposure to naturally occurring antigens such as bacteria, viruses or fungi. Immunization, Passive A means to produce a temporary immune response against an infectious agent or toxin by giving preformed antibodies actively produced in another person or animal in the form of serum or gamma globulin. Immunocompromised Used to describe persons with an underdeveloped (as in the very young) or impaired immune system. The impairment may be a natural deterioration from age, or may be caused by disease or by the administration of immunosuppressive drugs. Immunogenic See Antigenic Immunoglobulin (Ig) A subgroup of globulins that are classified as alpha, beta and gamma according to lipid or carbohydrate content and physiological function. Serum Igs belong to the gamma group and constitute a family of glycoproteins that bind antigens. Immunoglobulin A (IgA) Major class of immunoglobulins found in mammalian serum, body fluids. Of the five types of Igs (IgM, IgG, IgA, IgE and IgD) in the body, only IgE has been shown to be involved in allergic reactions. It is responsible for the symptoms seen in patients with allergic rhinitis, asthma and eczema. The Fabs include the antigen combining sites while the Fc region consists of the remaining constant sequence domains of the heavy chains and contains cell binding and complement binding sites. IgGs act on pathogens via agglutination, opsonization, activation of complement-mediated reactions against cellular pathogens and/or neutralization. IgG2 differs from the rest in that it cannot be transferred across the placenta and IgG4 does not fix complement. Immunologic Memory the capacity of an organism to mediate effective responses to previously encountered antigens. They have not metastasized beyond the original site where the tumor was discovered. Inflammation the response of the immune system to an injury caused by irritation, infection, physical damage or chemically-induced cell stress. Local reactions at the site of injury cause immune cells to be recruited into the area, leading to the destruction and removal of the affected tissues and to wound repair. The five symptoms of inflammation are redness, heat, swelling, pain and dysfunction of the affected area, although not all five need be present at any one time. Influenza An acute viral respiratory tract infection caused by influenza viruses A, B or C. It is characterized by inflammation of the nasal mucosa, the pharynx and conjunctiva and by headache, generalized myalgia, fever and chills.
Just as a haematoma under the tongue can be an indicator for a in most instances , immediate referral is unnecessary and it is fractured mandible , a subconjunctival haematoma may indicate an reasonable to postpone referral for 4?7 days. A direct blow to the orbit or orbital rim is usually required to sustain this fracture type. Diplopia commonly occurs when the orbital walls are fractured infraorbital nerve Figure 10. The same patient after maxillofacial intervention and correct anatomical reposition and fxation of the segments. Note: the incision scars are hiding in the folds of the eyelids leading to an Figure 11. Vision must be assessed, and if intact, referral can usually be delayed for 7?14 days. Maxillary and midface fractures midface fractures typically run along bilateral lines of weakness in the midfacial skeleton. Clinical investigation midface fractures are characterised by symmetrical facial swelling, bilateral periorbital ecchymosis and bilateral subconjunctival/ periorbital haemorrhages (raccoon signs) with flattening and elongation of the midface. Depressed anterior table continued blood clots in the posterior pharyngeal region, as the initial frontal sinus fracture clotting in the maxillary antrum is cleared into the posterior pharynx. Imaging All suspected cases of midface fracture require comprehensive ct examination, particularly with orbital involvement. Obvious cosmetic deformity associated with frontal sinus fracture parathesia or severe facial bruising. Management Anterior table fractures do not require immediate referral and can be referred up to 4?7 days postinjury. Retrobulbar haematoma requires immediate will make the area appear to resolve, though the deformity will return treatment. As with all serious injuries, initial assessment and the patient has decreased visual acuity and possibly decreased management should be conducted by Atls guidelines. White eye blowout fractures of the orbit (also termed trapdoor Vital symptoms/signs/conditions not to fractures) are a poorly recognised entity, resulting in delayed be missed management and poor outcomes for patients. We stress that in assessing any eye movement (Figure 15) with nausea and occasional vomiting. Summary maxillofacial injuries are unfortunately becoming a more common Traumatic optic neuropathy presentation to general practice. Acute orbital compartment syndrome after lateral blow?out fracture effectively relieved by lateral cantholysis. Br J oral maxillofac surg traumatic optic neuropathy and white eye blowout fracture. Although uncommon, any patient with a panfacial fracture should also be transferred to hospital immediately. Date of Revision: 17300 Trans-Canada Highway December 6, 2016 Kirkland, Quebec H9J 2M5 Submission Control No: 198215 C. White capsule shells contain sodium lauryl sulphate and colloidal silicon dioxide. This decrease in pregabalin oral clearance is consistent with age-related decreases in creatinine clearance. Specific symptoms included swelling of the face, mouth (tongue, lips, and gums), neck, throat, and larynx/upper airway. There have been reports of life-threatening angioedema with respiratory compromise requiring emergency treatment. Some of these patients did not have reported previous history/episode(s) of angioedema. Hypersensitivity There have been postmarketing reports of hypersensitivity reactions (eg, skin redness, blisters, hives, rash, dyspnea, and wheezing). Pregabalin should be discontinued immediately if such symptoms occur (see Post-Marketing Adverse Drug Reactions). Renal Failure In both clinical trials of various indications and post-marketing database, there are reports of patients, with or without previous history, experiencing renal failure while receiving pregabalin alone or in combination with other medications. Discontinuation of pregabalin should be considered as it has shown reversibility of this event in some cases. In clinical studies across various patient populations, comprising 6396 patient-years of exposure in 8666 patients ranging in age from 12 to 100 years, new or worsening-preexisting tumors were reported in 57 patients. The most common malignant tumor diagnosed was skin carcinoma (17 patients) followed by breast carcinoma (8 patients), prostatic carcinoma (6 patients), carcinoma not otherwise specified (6 patients), and bladder carcinoma (4 patients). Ophthalmological Effects In controlled studies, pregabalin treatment was associated with vision-related adverse events such as blurred vision (amblyopia) [6% pregabalin and 2% placebo] and diplopia (2% pregabalin and 0. Approximately 1% of pregabalin-treated patients discontinued treatment due to vision-related adverse events (primarily blurred vision). Of the patients who did not withdraw, the blurred vision resolved with continued dosing in approximately half of the cases (see Post-Marketing Adverse Drug Reactions). Prospectively planned ophthalmologic testing, including visual acuity testing, formal visual field testing and dilated funduscopic examination, was performed in over 3600 patients. In these patients, visual acuity was reduced in 7% of patients treated with pregabalin, and 5% of placebotreated patients. Visual field changes were detected in 13% of pregabalin-treated, and 12% of placebo-treated patients. Funduscopic changes were observed in 2% of pregabalin-treated and 2% of placebo-treated patients.
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Three sensitivity analyses were performed , but none addressed the potential heterogeneity seen across included trials in the networks . Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease? Chronic obstructive pulmonary disease: definition , clinical manifestations, diagnosis, and staging. Health fact sheets: Chronic obstructive pulmonary disease in Canadians, 2009 to 2011 [Internet]. Inhaled corticosteroids and the risk of mortality and readmission in elderly patients with chronic obstructive pulmonary disease. Effectiveness of inhaled corticosteroids in chronic obstructive pulmonary disease: immortal time bias in observational studies. Sputum eosinophilia predicts benefit from prednisone in smokers with chronic obstructive bronchitis. Inspiolto Respimat (tiotropium (as tiotropium bromide monohydrate) and olodaterol (as olodaterol hydrochloride) inhalation solution): 2. Duaklir Genuair aclidinium bromide/formoterol fumarate dihydrate inhalation powder 400 mcg/12 mcg [product monograph]. Anoro Ellipta umeclidinium (as umeclidinium bromide) and vilanterol (as vilanterol trifenatate) dry powder for oral inhalation 62. Ultibro Breezhaler : indacaterol (as maleate)/glycopyrronium (as bromide) inhalation powder hard capsules 110 mcg/50 mcg per capsule [product monograph]. Efficacy of tiotropium + olodaterol in patients with chronic obstructive pulmonary disease by initial disease severity and treatment intensity: A post hoc analysis. Tiotropium+olodaterol shows clinically meaningful improvements in quality of life. Guidance for industry: chronic obstructive pulmonary disease: developing drugs for treatment. European respiratory monograph: clinical handbooks for the respiratory professional. Variability of breathlessness measurement in patients with chronic obstructive pulmonary disease. Contents, interobserver agreement, and physiologic correlates of two new clinical indexes. Is performed with an instrument called a "spirometer" Spirometer is an instrument that measures and records the volume of inhaled and exhaled air, used to assess pulmonary function. The reduction of all the parameters is proportional and concomitant Obstructive pulmonary disease Obstructive pulmonary disease generate the concave curves that represent the slowing of expiratory flow through the respiratory system. Ranks among the 10 conditions that account for the most ambulatory office visits to U. No evidence supports routine testing or antimicrobial therapy for these syndromes. Suspect pneumonia if focal abnormalities, hypoxia, widespread diffuse rales (diffuse infiltrates on cxr). Relatively uncommon due to childhood immunizations Children > 10 years of age and adults. Typically milder disease, though is still transmissible Red Book Online Visual Library, 2009. Principles of Appropriate Antibiotic Use for Treatment of Uncomplicated Acute Bronchitis in AdultsBronchitis in Adults Bronchitis: Background. National trends in the use of antibiotics by primary care physicians for adult patients with cough. Significant heart, lung, liver, antibiotics, but even in persons >65, the kidney, neuromuscular disease, Number Needed to Treat was 39. Treat for postnasal dripdi Antihistamine-decongestantAntihistamine decongestant Ace-I? Am J Respir Crit Care Med 160:406-410, 1999 Non-asthmatic eosinophilicNon-asthmatic eosinophilic Diagnosis of non-asthmaticDiagnosis of non-asthmatic bronchitisbronchitis eosinophiliceosinophilic bronchitisbronchitis. Normal spirometry eosinophilia that respondseosinophilia that responds to inhaledto inhaled corticosteroids. Therefore, any disorder causing hypoxia is a potential indication for oxygen administration. But the tissue oxygen delivery depends upon an adequate function of cardiovascular (cardiac output and flow), haematological (Hb and its affinity for oxygen) and the respiratory (arterial oxygen pressure) systems. Therefore, tissue hypoxia is not relieved by oxygen therapy alone functioning of all the three organ systems also needs to be improved. Proper monitoring of oxygen therapy is recommended to ensure adequate oxygenation and to save precious oxygen from wastage. The use of pulse oximeter is a simple, quick, non-invasive, and reliable method to assess it. A disorder in any portion of tissues depends on many factors like ventilation, 2 these systems can lead to respiratory failure. Oxygen therapy is required for respiratory failure in many conditions like severe During respiratory failure, there is an inability to asthma, chronic bronchitis, pneumonia, and keep the arterial blood gases at normal level, while myocardial infarction, etc. Through this article, breathing air at rest at sea level, and the partial we have made an attempt to review the pressure of oxygen is usually below 60 mmHg physiological basis of hypoxia, basis of oxygen with or without partial pressure of carbon dioxide therapy, its indications, administration devices, above 49 mmHg in arterial blood. Acute respiratory failure develops suddenly or the respiratory system is concerned with the slowly if lungs are already diseased; while delivery of an adequate amount of oxygen to chronic respiratory failure develops slowly due and elimination of a corresponding amount of to underlying lung disease. Respiratory failure carbon dioxide from the cells of the body and may occur even if lungs are normal as in maintenance of normal acid-base balance in diseases of nervous system, chest wall, or upper the body.
Play therapy Clinical assessment of the child Young children learn and process experiences through playing . Investigations Elective surgery should be postponed 2-4 weeks if the child is unwell , Most children do not require routine pre-operative screening or if there is any suggestion that the child has a lower respiratory tract investigations unless there is a specifc clinical indication such as infection: anaemia or sickle cell disease . The main points to address include: Investigations It is essential that all children are weighed on the day of surgery. Children who are not adequately fasted Special investigations are not usually required on the day of surgery. Speak directly to the child using simple and age-appropriate other issues language in the presence of the parents to help ensure a fuller understanding of proceedings. Preparation of environment Consider a child friendly environment with brightly coloured pictures. Give an opportunity for the child and parents to ask questions useful distraction. Antiemesis quiet and withdrawn due to pain, fear, hypotension or sepsis, with little interest in interacting with their environment (state of passivity). Topical anaesthesia of suitable veins (using local anaesthetic cream) septic or hypovolaemic shock. This Tere has been a reduction in routine anxiolytic pre-medication over can often be attenuated by a full explanation of the peri-operative plan. Appropriate preparation of the child combined with physiological issues parental presence at induction is sufcient in the majority of cases. All of the conditions outlined in table 2 above can also be present in Tere are still situations where anxiolytics are appropriate: the acutely ill child and the principles of management are the same. Balance the need for further investigation of pre-existing disease against the urgency. Key aspects of the assessment of the critically ill child Anxiolytics should be used with caution if there is a history suggestive are outlined in Table 4. Inadequate resuscitation of a critically ill child prior to induction can result in severe peri-operative haemodynamic instability. Midazolam tastes bitter, which can be disguised by mixing and are discussed further on page 223. A small amount of water with tablets or a minimal Anaesthetic induction and maintenance in emergency situations is volume of analgesic elixir does not signifcantly increase the risk of difcult use extreme caution. More thorough reviews of the management and assessment of the Induction critically ill child, including cardiopulmonary resuscitation, are The presence of parents at induction has become more common in elsewhere in this Update (pages 209, 223, 264). You will need to prepare the parent with a description of what Patients awaiting emergency surgery should be nil by mouth for solids to expect, their role, and when to leave. Tere are certain situations when it may not be appropriate to allow However, a risk-beneft decision may be required depending on surgical parents to be present at induction: urgency. Beware the use of pre-operative opioids, which can lead to a signifcant delay in gastric emptying. Neonates and babies there is little beneft to children under 6 prudent in this situation. Recognition of the critically ill child clinical signs of concern airway and breathing: A very sensitive sign. Respiratory rate Recession, grunting, accessory muscle use and gasping are especially concerning. Respiratory efort Look for poor expansion or reduced breath sounds on auscultation. Efcacy Heart rate, skin colour, conscious level will alter if the child is hypoxic. Efects on other organs circulation: May be raised due to shock (septic or hypovolaemic), pain, or anxiety. Capillary refll Five seconds of pressure on the sternum should result in capillary refll in 2-3 seconds. Peripheral temperature the peripheries may be warm in early septic shock, cold in established shock, or simply cold due to a cool ambient temperature. Preoperative fasting practices in smooth the preoperative process and avoid cancellations on the day. Preparing children for the operating room: psychological Children presenting for emergency surgery may be critically ill and issues. Anesthesia for the Child with an Upper Respiratory measures are taken prior to induction of anaesthesia. Anaesthesia Tutorial of the Week 23 (2006) Glynn Williams Correspondence email: willig3@gosh. A survey predictable, to bring pain rapidly under control, and at the time found that 40% of paediatric surgical to continue pain control after discharge from hospital. Since should be regularly reassessed and changes made as then increased interest in this area has led to a better Summary required. Appropriate pain assessment is vital to aid understanding of the developmental neurobiology of this. This should involve clinical assessment of the It is both desirable and pain and analgesic pharmacology and, consequently, child and the use of an appropriate pain scoring tool possible to achieve allowed for the development of safer and more efective to identify discomfort and monitor the efcacy of any safe, efective analgesia analgesic techniques for children of all ages. Due to the subjective nature of for children of all ages using individualised pain pain and the lack of a reliable measure many diferent pain perception management planning tools are available. If the child is able to communicate During foetal, neonatal and infant life the nervous and combined multimodal their pain then a self reporting score, such as the pain system is continually evolving. If the child cannot and functional changes to occur continuously in communicate then other tools using behavioural and response to the child`s needs as it grows and develops.
The appointed group (the writing group) may utilize experts from other misinformation regarding safe infant and child care . A draft document is created and reviewed by participating individuals , What can be done to provide the court accurate. With these comments, the writing group revises the document and submits to the governing body for approval the admissibility of expert evidence g. The governingbody circulates the document tothe society membership for comment and if necessary further revisions In current day jurisprudence, admissibility of medical or scih. After this comprehensive creation and review process is completed, the entific expert testimony requires some judicial assessment of document is published the reliability of that testimony. But in because it is supported by the evidence and has been generally any legal jurisdiction, the medical precept that is considered accepted in the relevant field of pediatric medicine. Thus, consensus statements present a unique opportunity to provide courts with a way to know general medical thought about a particular medical topic. Table 6 describes the rigorous process used to conthat infant shaking can cause brain trauma. Thus, courts can be assured that arguments include: (1) a biased rush to judgment on the diagpractice promulgation of consensus statements has been vetnosis of abuse; (2) exclusive diagnostic reliance on a triad of ted through a process that offers all members a way to consymptoms; (3) diagnosis by default; (4) an absence of neck tribute to the professional statements of that medical society. Courts need experts to provide general information about from France, in fact, the perpetrators were offered no reason to infant anatomy, imaging technologies and the interpretation of confess because leniency cannot be offered via French law) medical images and laboratory results. These arguments are repeatedly raised in court dedecision-making role, judges and juries must assess the weight spite the fact that they have never been empirically substantiof the medical literature and differentiate between persuasive ated or are patently false. Pediatr Radiol (2018) 48:1048?1065 1059 Because the suggestion that denialist views are supported by negligent). The denialists have tried to cretwo purported literature reviews: Donohoe in 2003 and ate a medical controversy where there is none. Both articles are flawed by (1) the diagnosis of murder argument is obviously wrong improper search and systemic review questions, (2) improper because it falsely implies that medical opinion testimony, by criteria for assessing bias and (3) inequitable application of its nature, resolves all legal issues. In the final analysis, Donohoe used only 23 Defense attorneys and few medical witnesses who promularticles to reach his erroneous conclusions . This alternative agenissue evidence-based consensus statements to help courts, the da has no role in true science and can result in infant news media and the public to address these issues, we anticharm through shaking and neglect, through avoidance of ipate that they will also play a greater role in curbing and emergency medical intervention. Pediatrics found a high degree of medical consensus that shaking a young child can cause subdural hematoma, severe retinal hemorrhage, coma or death . The question to be answered is, Is there a evidence is required to determine who committed the act and medical cause to explain the findings or did this child to determine the level of intent. There is no reliable medical evidence that the following understanding aht in infants children. Accessed 17 April 2018 processes cause the constellation of injuries associated 3. Pediatr Radiol in later collapse, coma or death from acute rebleeding 46:587?590 into a previously asymptomatic chronic subdural hema6. Bazelon E (2011) Shaken-baby syndrome faces new questions in the setting of benign enlargement of the subarachnoid court. After medical diagnosis, in many hospitals a multidiscibased study of inflicted traumatic brain injury in young children. Caffey J (1946) Multiple fractures in the long bones of infants term triad is a legal convention that falsely mischaracsuffering from chronic subdural hematoma. Caffey J (1972) the parent-infant traumatic stress syndrome; public about general acceptance, what is accurate (Caffey-Kempe syndrome), (battered babe syndrome). Am J medical information and what is non-evidence, Roentgenol Radium Therapy Nucl Med 114:218?229 speculative or professionally irresponsible etiologi14. Its potential residual effects of permanent brain damage and mental cal hypotheses. Caffey J (1974) the whiplash shaken infant syndrome: manual should help the court recognize unsubstantiated medical shaking by the extremities with whiplash-induced intracranial and expert testimony. Am J Roentgenol Radium Christian, Hedlund, Dias, Nelson, Palasis, Rossi and Offiah provide medTherapy Nucl Med 69:413?427 ical?legal expert work in child abuse cases. American Academy of Pediatrics (2015) Understanding abusive very young children: mechanisms, injury types and ophthalmologhead trauma in infants and children: answers from America?speic findings in 100 hospitalized patients younger than 2 years of diatricians. In: Proceedings of 20th Stapp Car Crash immature brain after traumatic brain injury. Adamsbaum C, Grabar S, Mejean N et al (2010) Abusive head death resulting from short falls among young children: less than 1 trauma: judicial admissions highlight violent and repetitive shakin 1 million. Vinchon M, de Foort-Dhellemmes S, Desurmont M et al (2010) Neurosurg 61:273?280 Confessed abuse versus witnessed accidents in infants: comparison of clinical, radiological and ophthalmological data in corrob54. Emerg Med J 27: neurotrauma: proceedings of a conference sponsored by 207?208 Department of Health and Human Services, Oct. Neurosurg Focus 8:1?5 the pediatric Glasgow coma scale score in the evaluation of chil61. Yonsei Med J 45:229 neuroradiological features distinguish abusive from non-abusive 65. Report of cases and review of the Parenchymal brain laceration as a predictor of abusive head trauliterature. Arch Dis Child Fetal Neonatal accidental head injury: a 20-year comparative study of referrals to Ed 95:F144?F145 a hospital child protection team. Child Youth Serv Rev 33: diagnosis with non-accidental trauma in patients younger than 2 1374?1382 years of age. J Trauma Pediatrics 108:636?646 31:1350?1352 1062 Pediatr Radiol (2018) 48:1048?1065 71.