Podcast
Questions and Answers
What was the primary mechanism of injury reported in the case scenario that led to the patient's unconsciousness?
What was the primary mechanism of injury reported in the case scenario that led to the patient's unconsciousness?
- Fall from a motorcycle (correct)
- Assault with a blunt object
- Fall from a height
- Motor vehicle collision
Upon arrival of the ambulance, what was the patient's initial level of consciousness?
Upon arrival of the ambulance, what was the patient's initial level of consciousness?
- Regained consciousness (correct)
- Fluctuating level of consciousness
- Responsive only to painful stimuli
- Completely unresponsive
Which of the following behavioral presentations did the patient exhibit upon regaining consciousness at the accident scene?
Which of the following behavioral presentations did the patient exhibit upon regaining consciousness at the accident scene?
- Euphoric and disoriented
- Agitated and confused (correct)
- Calm and cooperative
- Lethargic and withdrawn
What critical piece of safety equipment was noted to be absent at the scene of the motorcycle accident?
What critical piece of safety equipment was noted to be absent at the scene of the motorcycle accident?
What was the approximate time duration between the incident and the patient's arrival at the nearest hospital?
What was the approximate time duration between the incident and the patient's arrival at the nearest hospital?
Upon arrival at the hospital, what device was already in place to manage potential spinal injury?
Upon arrival at the hospital, what device was already in place to manage potential spinal injury?
What type of intravenous access was established by paramedics in the pre-hospital setting?
What type of intravenous access was established by paramedics in the pre-hospital setting?
During the secondary survey, decreased wrinkles on the right forehead, difficulty closing the right eye, and deviation of the mouth to the left suggest dysfunction of which cranial nerve?
During the secondary survey, decreased wrinkles on the right forehead, difficulty closing the right eye, and deviation of the mouth to the left suggest dysfunction of which cranial nerve?
Loss of sensation in the lower third of the face on the right side is most likely related to the branch of which cranial nerve?
Loss of sensation in the lower third of the face on the right side is most likely related to the branch of which cranial nerve?
Impaired extraocular movement of the right eye suggests potential injury to which cranial nerve(s)?
Impaired extraocular movement of the right eye suggests potential injury to which cranial nerve(s)?
A 'normal eFAST examination' typically assesses for free fluid in which of the following anatomical locations?
A 'normal eFAST examination' typically assesses for free fluid in which of the following anatomical locations?
According to the radiology report, a linear fracture extends from the left frontal bone into the left squamous temporal bone. This fracture is described as extending into which cranial fossa?
According to the radiology report, a linear fracture extends from the left frontal bone into the left squamous temporal bone. This fracture is described as extending into which cranial fossa?
Fractures involving the sella turcica are significant because of their proximity to which endocrine gland?
Fractures involving the sella turcica are significant because of their proximity to which endocrine gland?
Evidence of blood within the middle ear cavity, as noted in the radiology report, is most indicative of a fracture involving which bone?
Evidence of blood within the middle ear cavity, as noted in the radiology report, is most indicative of a fracture involving which bone?
A right orbital floor blow-out fracture with herniation of orbital fat into the maxillary sinus would most likely result in which clinical sign?
A right orbital floor blow-out fracture with herniation of orbital fat into the maxillary sinus would most likely result in which clinical sign?
What type of intracranial hematoma is described as a 'large biconvex epidural haematoma' in the radiology report?
What type of intracranial hematoma is described as a 'large biconvex epidural haematoma' in the radiology report?
Subfalcine herniation, mentioned in the radiology report, involves the displacement of which anatomical structure?
Subfalcine herniation, mentioned in the radiology report, involves the displacement of which anatomical structure?
The patient's GCS upon arrival in the Emergency Department is calculated based on the findings: 'drowsy, no spontaneous eye opening but opens to pain, utters inappropriate words, flexion/withdrawal to pain'. What is the patient's GCS score?
The patient's GCS upon arrival in the Emergency Department is calculated based on the findings: 'drowsy, no spontaneous eye opening but opens to pain, utters inappropriate words, flexion/withdrawal to pain'. What is the patient's GCS score?
Anisocoria, with the right pupil 3mm and left pupil 4mm, and a sluggish reaction of the left pupil to light suggests which of the following?
Anisocoria, with the right pupil 3mm and left pupil 4mm, and a sluggish reaction of the left pupil to light suggests which of the following?
A blood pressure of 170/100 mmHg and heart rate of 65 bpm in the context of a head injury is most concerning for:
A blood pressure of 170/100 mmHg and heart rate of 65 bpm in the context of a head injury is most concerning for:
Temporary hyperventilation to an EtCO2 of 30mmHg is used in head injury management primarily to achieve:
Temporary hyperventilation to an EtCO2 of 30mmHg is used in head injury management primarily to achieve:
Mannitol (20%) is administered in head injury management for what primary pharmacological effect?
Mannitol (20%) is administered in head injury management for what primary pharmacological effect?
Why would a patient with facial nerve palsy, as in this case, require eye drops?
Why would a patient with facial nerve palsy, as in this case, require eye drops?
In the 'Management Decision-Making' flowchart, what is the primary factor that determines whether to proceed with 'Burr hole evacuation or craniectomy/otomy' versus 'Retrieval'?
In the 'Management Decision-Making' flowchart, what is the primary factor that determines whether to proceed with 'Burr hole evacuation or craniectomy/otomy' versus 'Retrieval'?
The patient's sodium level is 158 mEq/L (Reference range: 135-145 mEq/L), plasma osmolality is 302 mOsm/kg (Reference range: 275-295 mOsm/kg) and urine osmolality is 243 mOsm/kg (Reference range: 300-900 mOsm/kg). These findings are most consistent with which condition?
The patient's sodium level is 158 mEq/L (Reference range: 135-145 mEq/L), plasma osmolality is 302 mOsm/kg (Reference range: 275-295 mOsm/kg) and urine osmolality is 243 mOsm/kg (Reference range: 300-900 mOsm/kg). These findings are most consistent with which condition?
Flashcards
Glasgow Coma Scale (GCS)
Glasgow Coma Scale (GCS)
Brief neurological assessment to measure level of consciousness.
Epidural Hematoma
Epidural Hematoma
Collection of blood outside the blood vessels, but within the skull.
Anisocoria
Anisocoria
Difference in pupil size between the eyes.
Mass effect
Mass effect
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Herniation
Herniation
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Positioned in 30°Head up
Positioned in 30°Head up
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IV Mannitol
IV Mannitol
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Temporarily hyperventilation
Temporarily hyperventilation
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Temporal burrhole procedure
Temporal burrhole procedure
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Facial Nerve Palsy
Facial Nerve Palsy
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Intubation
Intubation
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Study Notes
- A middle-aged male was found unconscious on the roadside embankment after reportedly falling from their motorcycle.
- Emergency services were alerted by a passing driver.
- The patient had regained consciousness upon the ambulance's arrival but exhibited irritability, aggression, and confusion.
- The patient communicated and complied with simple commands and displayed purposeful movement in all limbs.
- Vital signs were within the normal range.
- There was no evidence of a helmet.
- The patient was brought to the nearest hospital approximately 40 minutes later.
- The patient was in a cervical collar, and paramedics had obtained IV access.
- There are decreased wrinkles on the right forehead, difficulty closing the right eye, and deviation of the mouth to the left.
- There is loss of sensation in the lower third of the face on the right side.
- There is possible loss of sensation on the upper lip, teeth, and gums on the right.
- The patient has impaired extraocular movement of the right eye.
- No other significant injuries detected on head-to-toe examination and log roll.
- The eFAST examination was normal.
- A linear fracture extends from the left frontal bone into the left squamous temporal bone.
- This fracture extends into the middle cranial fossa.
- Fractures involving the Sella turcica and sphenoid sinus are observed.
- Fractures involving the right foramen ovale and the otic capsule of the right petrous temporal bone are noted, with evidence of blood in the middle ear cavity.
- There is a right orbital floor blowout fracture with herniation of orbital fat into the maxillary sinus.
- A large biconvex epidural haematoma is present in the left frontotemporal region, causing mass effect, midline shift, and sub-falcine herniation.
- Neurosurgical consultation was done over the phone; CT scans were reviewed, and the patient was requested to transfer to the tertiary care unit (1.5 hours driving distance).
- In the ED, the patient appeared drowsy with no spontaneous eye-opening but opened eyes in response to pain.
- The patient utters inappropriate words in response to questioning and exhibits flexion/withdrawal in response to painful stimuli.
- Blood pressure: 170/100.
- Heart rate: 65.
- Neurological: Anisocoria with the right pupil 3mm and the left pupil 4mm.
- The left pupil has a sluggish pupillary reaction to light.
- The patient is sedated for muscle relaxation.
- The patient is intubated and temporarily hyperventilated to an EtCO2 of 30mmHg for 5-10 minutes (stop if signs resolve).
- The patient is positioned in 30°Head up.
- The cervical collar is removed, and restrictive endotracheal tube ties are loosened.
- IV mannitol 20%: 1g/kg over 20 mins.
- The patient is prepared for a Temporal burrhole procedure.
- The patient is immediately booked into the theatre and within minutes an emergency evacuation of hematoma using the burr hole procedure.
- The patient was transferred to Neurosurgical intensive care.
- After a week, the patient is clinically improved except for the facial nerve palsy and will still require eye drops in the right eye.
- Over the first 24 hours in the hospital, the patient is producing urine at a faster rate than IV fluid being infused.
- Results:
- Na+: 158 (Reference Range: 135-145 mEq/L)
- Plasma osmolality: 302 (Reference Range: 275-295 mOsm/kg)
- Urine osmolality: 243 (Reference Range: 300-900 mOsm/kg)
- On initial examination in the emergency department, the patient complains of neck pain, dizziness, and light headedness, and the peripheries are abnormally warm.
- Blood pressure: 86/54 mmHg
- Heart rate: 53 Beats per min
- Temperature: 36.8°C
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