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Subdural hemorrhage
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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...
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...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
Neck Guard Debate a. Pros b. Cons Conclusions: Will it take a death to make NHL officials change there minds on the policies regarding neck guards like they did with helmets after the death of Bill Masterton. Are current equipment regulations enough to keep our hockey athletes safe? I ask this after the life threatening injury that recently occurred here in Buffalo. However this isn’t the first time that the NHL (National Hockey League) has seen injuries of this magnitude. What were these injuries?
Wearing headgear has many positives, reducing injuries is the most obvious one and it could be argued that its help reduces the chance of injuries and even death. At an elite level, Chelsea goalkeeper, Petr Cech is convinced that wearing headgear saved him from suffering extended injuries after colliding with Fulham striker Orlando Sa back in September 2011. Headgear offers a form of padding when worn. It allows juniors and elite athlete’s the reduced chance of head wounds. By this it means it allows for less “cracked skulls”, scars, wounds and so on. It gives a stronger protection on the softer part of the skull which is more prone to damage...
Recognition, response and treatment of deteriorating patients are essential elements of improving patient outcomes and reducing unanticipated inpatient hospital deaths (Fuhrmann et al 2009; Mitchell et al 2010) appropriate management of the deteriorating patient is often insufficient when not managed in a timely fashion (Fuhrmann et al 2009; Naeem et al 2005; Goldhill 2001). Detection of these clinical changes, coupled with early accurate intervention may avoid adverse outcomes, including cardiac arrest and deaths (Subbe et al. 2003).
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).
While doing research on how concussions affected the brain, they came upon SIS. SIS raised concern in the sports community, they found that they need to be more cautious with the care and d management of athletes the suffered head injuries. '" occurs when an athlete who has sustained an initial head injury, most often a concussions, then sustains a second head injury before symptoms associated with the first have fully healed (Cantu and Voy 1995).'" Michael Bay was a athlete that got a concussions, shortly after he was hit again while being in practice. Mr. Bay die in a deep coma, after the medical examiner perform the autopsy it was found that Michael cause of death was a massive cerebral edema ( a cerebral edema is "the accumulation of fluid in and resultant swelling of the brain that may be caused by trauma, a tumor, lack of oxygen at high altitudes, or exposure to toxic substances." MedlinePlus). The next one is the intracranial injury, there are four major types of intracranial injuries: epidural hematoma, subdural hematoma, intracranial hematoma, and cerebral contusion. The epidural hematoma is a bleeding that develops between the dura and the cranial bones. Subdural hematoma is also a bleed, but it develops below the dura mater. The intracranial hematoma is a bleed that happens within the brain tissue. And the last one the cerebral contusion is
middle of paper ... ... 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.
Football is one of the most popular sports in the world. It is played in a lot of different ways, fashions, and other countries. It can be a very brutal sport with players hitting at the intent to hurt one another. With these intents come great consequences. In recent years the head injuries involved with this brutal game play have been getting uncomfortably high. Many rules have had to be enforced for player safety, because of the increase of head injuries resulting in tragic effects on players both old and new. One of the injuries that have had the most devastating effects is the concussion.
Recent issues with the NFL not doing enough with head injuries has become a top news issue. the NFL has had several class action lawsuits against them. From several different head injuries that you can get, the post NFL injury is a very rough thing to deal with. Some say the ...
The only result from the testing consistent with a brain injury was the abnormal pupil response of the right eye (constriction) (Traumatic brain injury, 2015). The physical effects that could have pointed to a brain injury were the laceration to the right side of the gentleman’s head and the amount of blood loss. The complaints from the patient that may have insisted a brain injury included a severe headache, dizziness, and nausea (Traumatic brain injury, 2015).
Imaging utilized to support a diagnosis of a brain injury includes Computerized Tomography (CT) Scan, Magnetic Resonance Imaging (MRI), and Diffusion Tensor MRI (DTI). Brain CT is the test of choice for Emergency Department evaluation of brain injury including concussion. (15,16) Magnetic Resonance Imaging (MRI) has an important role in the evaluation of patients with persistent post-traumatic sequelae. MRI is more sensitive in showing small areas of contusion or petechial hemorrhage, axonal injury, and small extra-axial hematomas. (15,16) Diffusion Tensor MRI (DTI) may be more
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:
My colleague and I received an emergency call to reports of a female on the ground. Once on scene an intoxicated male stated that his wife is under investigation for “passing out episodes”. She was lying supine on the kitchen floor and did not respond to A.V.P.U. I measured and inserted a nasopharyngeal airway which was initially accepted by my patient. She then regained consciousness and stated, “Oh it’s happened again has it?” I removed the airway and asked my colleague to complete base line observations and ECG which were all within the normal range. During history taking my patient stated that she did not wish to travel to hospital. However each time my patient stood up she collapsed and we would have to intervene to protect her safety and dignity, whilst also trying to ascertain what was going on. During the unresponsive episodes we returned the patient to the stretcher where she spontaneously recovered and refused hospital treatment. I completed my patient report form to reflect the patient's decision and highlighted my concerns. The patient’s intoxicated husband then carried his wife back into the house.
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
D. standing near her room, breathing sharply. While asked what has just happened, she answered, ‘I feel dizzy and can faint!’ Mrs. D. then explained that she rose up from her chair in the television room and felt lightheaded. I decided to bring her to the room hoping she would feel less dizziness if she could sit. After consultation with my mentor and third year unit nursing student, I decided to perform measurement of her vital signs. Since only electronic sphygmomanometer was available for me that time, I had to use it for my procedure. Gladly, I discovered that I have already used such equipment in my previous nursing practice. Using the standard sized calf, I found that her blood pressure was 135/85, respirations were 16, and her pulse was 96 beats per minute (bpm). However, I decided to recheck the pulse manually, founding that it was irregular (78 bpm). The patient stated that she felt better after rest. Immediately after the incident I made a decision to explore carefully the medical chart of Mrs. D., along with her nursing care plan. That helped me to discover multiple medical diagnoses influencing her
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