In the case study provided, the 82 year old unconscious female needs an assessment and a differential diagnosis completed so that the paramedics know how to treat and to determine if the patient is time or transport critical. A differential diagnosis comes from the paramedics’ education and the patient’s history, current vitals signs, and pertinent knowledge gained from those at the scene. The paramedic must, after the differential diagnosis, have an understanding of the pathophysiological process and how this affects the patient.
The patient has an Acquired Brain Injury (ABI), which is an injury occurring after birth (State Government of Victoria, 2013). The patient also has traumatic brain injury (TBI), which is caused by a physical force resulting in damage to the brain. One aspect of finding a differential diagnosis is an understanding of the mechanism and pattern of injury (MOI/POI). When looking at brain injuries the MOI/POI can be separated into two parts, primary and secondary injuries. Primary injury is the one that occurs at that moment of impact, i.e. the table that causes a visible hematoma (Rosenfeld, 2012). The secondary injury is the cascade of events and medical conditions, which can aggravate the primary injury (Hughes & Cruickshank, 2011). In this patients case it is the chronic subdural haematoma that has caused secondary conditions, such as Cushing reflex and this has caused the patient to become unconscious.
Looking at the patients’ vital signs they are steadily deteriorating, and are worrying for an 82 year old female. The patients’ heart rate starts low but in the normal range however in the time of 15 minutes it drops to 54bpm, which is within the range of bradicardia (Curtis, Ramsden & Lord, 2011). T...
... middle of paper ...
...a Pty Ltd., (2014). Avapro HCT. Retrieved from https://www.mimsonline.com.au
National Health Service (NHS)., (2013). Causes of subdural haematoma. Retrieved http://www.nhs.uk/Conditions/Subdural-haematoma/Pages/Causes.aspx
Plaha, P., Malhotra, Dr., Heuer, Dr., & Whitfield, P. (2008). Management of Chronic Subdural Haematoma. Advances in Clinical Neurosceience (ANCR), 8 (5), 12-15. Retrieved from http://www.acnr.co.uk
Professional Health Systems., (2014). Vital Signs Table. Retrieved from http://prohealthsys.com/site/resources/assessment/physical-assessment/vital-signs/vital_signs_table/
Rosenfeld, V.J., (2012). Practical management of head and neck injury. Chatswood, N.S.W : Elsevier Australia
State Government of Victoria., (2013). Acquired brain injury. Retrieved from http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Acquired_brain_injury?open
In recent years, there has been an increase in research investigating the long-term effects of repeated head trauma on the brain, especially in athletes. Following his discovery of chronic traumatic encephalopathy (CTE), Dr. Bennet Omalu inspired a movement of research aimed at establishing better safety standards and protocols in football. It was not until 2002 that the initial connection between repetitive head trauma, such as concussions, and brain injury was suspected (Ott, 2015).
The treatment priorities of the registered nurse upon admission to the emergency department are as follows; within the first 10 minutes of Mr. Bronson’s arrival to the emergency department begin a 12 lead ECG. Assess Mr. Bronson’s vitals heart rate, blood pressure, respiratory rate, oxygen saturation, and administer oxygen 2-4 liters via nasal cannula (Sen, B., McNab, A., & Burdess, C., 2009, p. 19). Assess any pre hospital medications, and if he has done cocaine in the last 24 hours. At this time, the nurse should assess Mr. Bronson’s pain quality, location, duration, radiation, and intensity. Timing of onset of current episode that brought him to the emergency room, any precipitating factors, and what relieves his chest pain.
Did you know, that someone suffers from a brain injury every 21 seconds (Haas)? Children get concussions all the time, and most of the time they go unnoticed. The majority of concussions happen when one is playing a sport such as football, hockey, or lacrosse. Many famous athletes have had their careers, even their lives cut short due to concussions. Brain damage and death can result from serial concussions (Schafer). When one suffers from a concussion, one’s brain needs time to recover physically and mentally. Between 2002 and 2006, statistics showed that 52,000 people died from concussions and about 275,000 were hospitalized (Fundukian). Everyone’s recovery process is different (“Injury and Pain Care”). Although concussions seem minor, they are very serious brain injuries that may result in severe damage to one’s brain.
A secondary survey was undertaken encompassing a patient history and head to toe assessment to identify the extent of the patient’s injuries as stated by I. Greaves, K.Porter, T.Hodgetts and M.Woodard (2006). He was found to have a 2-inch haematoma to the back of the head and a 1inch laceration ...
Chronic Traumatic Encephalopathy, previously referred to as dementia pugilistica, can be understood as a tauopathic, neurodegenerative and neuropsychiatric disease. While there is no neurobiological or neuropathological explanation as to why CTE occurs, the majority of researchers believe the disease is strongly related to previous head injuries. An individual suffering from CTE will most likely experience changes in their mood, behavior and cognition. Because this is a relatively new area of research, there are still a vast amount of unknowns pertaining to the disease’s symptoms, pathology, and natural course.
Thesis: Concussions affect children and adults of all ages causing physical, emotional and metal trauma to a person and their brain.
As the quantity of patients expanded, it ought to have been obvious that one registered Nurse and one Licensed Practical Nurse were insufficient to look after the patients. The emergency department ought to be viewed as a high priority location, and should have staffed with more Registered Nurses; Licensed Practical Nurse essentially do not have the training and abilities to assess patients or delegate the workload. Dangerous actions such as moderate sedation on a patient with no supplemental oxygen or EKG observing. The patient seems to have been overmedicated, with insufficient time between medications to decide his actual level of
...l pressure’”(Beebe & Myers, 2011, p.278). This intracranial could be secondary to trauma to the head and intracranial hemorrhage or a tumor.
In this article, “Heads up: Concussion risks prompt more soccer players to visit the ER” written by the Associated Press, the researchers express concerns about head injuries, specifically concussions. This article is directed towards soccer players aged from 7 to 17 and their parents and teaches how the concussions happen and the possible ways to treat them. This study is based on 25 years of evidence and shows the growing popularity of soccer and how it is causing more and more concussions each year. Just behind football, soccer has the second highest number of injured players. Contrary to prior belief, soccer concussions do not happen from head balls, but from when two players’ heads collide when jumping to head the ball. Concussions can be avoided though. Sports medicine experts are saying that tensing neck muscles can help prevent
McCrory et al 2009. P.McCory, W. Meenwisse, K. Johnston, J. Divorft, M. Aubry, M. Malloy, R. Contu- Consensus statement on concussion in sport: The 3rd international conference on concussion in sport held in Zurich, November 2008, pg 434-448.
In this essay, I will touch on the pathophysiology of acute subdural hematoma, also known as subdural hemorrhage, its signs and symptoms and its treatments, together with the management expected from the nurses.
Epidural hematomas are a severe complication of head injuries and are considered to be a medical emergency. Although they may not be seen as often as subdural hematomas, they are much more serious and require emergency surgery. If epidural hematomas are not picked up quickly, they can result in severe neurologic deficits and even worse, death. A major concern in a patient with an epidural hematoma is failure to rescue by healthcare professionals. Failure to rescue is when healthcare professionals do not notice signs of a patients declining condition and subsequently fail to stabilize the patient (Gravey, 2015, p.145). This has become an increasing problem and has lead to numerous preventable disabilities and death. In order to avoid unnecessary harm to our patients it is essential that nurses are able to detect and notify any suspicion of epidural hematomas. Since nurses spend the majority of the time with the patient, they hold a significant role in early detection.
Over 1.7 million traumatic brain injuries are reported each year. According to reports the leading cause of brain injuries are from falls followed by motor vehicle accidents, and accidents that were a result of being struck by something. Falls account for 32.5% of traumatic brain injuries in the United States. 50% of all child brain injuries are from falling. 61 % of all traumatic brain injuries among adults are 65 years old or older. Traumatic brain injuries are very violent blows or jolts to the head or body that result in the penetration of the skull. Mild traumatic brain injuries can cause brief dysfunction of the brain cells. Serious brain injuries can cause bleeding, bruising, physical damage to other parts of the body and torn tissues. Brain injuries are more prevalent with males rather than females. Causes of brain injuries include:
Stocchetti, N., Pagan, F., Calappi, E., Canavesi, K., Beretta, L., Citerio, G., … Colombo, A., (2004). Inaccurate early assessment of neurological severity in head injury. Journal of Neurotrauma, 21(9), 1131-1140. doi:10.1089/neu.2004.21.1131
Physical effects are the most common with the less severe head trauma, but if not taken seriously can lead to much serious issues. The most basic physical symptom is just normal head and neck