1. Nkeiruka Orajiaka, MD, MPH* 2. Prasanna Kapavarapu, MD* 3. Gulafsha Chaudhary, MD* 4. Leonid Topper, MD* 5. Logeswary Rajagopalan, MD* 1. *Department of Pediatrics, Harlem Hospital, New York City, NY An 11-year-old boy presents to the pediatric emergency department after being hit as a pedestrian by a car in a motor vehicle crash. The patient reports no loss of consciousness and notes nonspecific chest pain and headache. On physical examination, his blood pressure is 123/64 mm Hg, heart rate is 82 beats/min, respiratory rate is 18 breaths/min, and oxygen saturation is 98%. He is conscious, is initially unable to talk due to pain, but is able to follow instructions and localize pain. He has significant abrasions to his face and scalp, blood-tinged clear drainage from both ears, and palpable tenderness along the subcostal margins of the chest. Findings from initial neurologic examination are normal, with a Glasgow Coma Scale score of 15 of 15, normal pupillary reflexes, a full range of ocular movements, and normal motor and sensory examination findings. Results of laboratory studies are normal. A chest radiograph shows normal heart and lung fields. Within hours …