12-years old boy was admitted to the Children’s Hospital at Dallas who was immob
ID: 3524206 • Letter: 1
Question
12-years old boy was admitted to the Children’s Hospital at Dallas who was immobilized on a rigid stretcher (not to move his head and/or trunk). The EMT crew reported that the boy was awake and alert after his biking accident at the park, but he was crying and complaining that he couldn’t get up and that he has “wicked headache”. He has severe bruises on his upper back and head, lacerations of his back and scalp, blood pressure is low, body T is below normal, lower limbs are paralyzed, and he is insensitive to painful stimuli below the nipples. Although he was alert at the arrival, soon he begins to drift in and out of unconsciousness. After CT scan the boy was immediately transferred into the operating room (OR).
Questions:
1. Why his head and torso were immobilized for transport to the hospital?
2. What do his worse neurological signs indicate? Relate this to the type of surgery that will be performed?
3. Assuming that patient’s sensory and motor deficits are due to a spinal cord injury, at what level do you expect to find a spinal cord lesion?
4. Based on your knowledge on Nervous System, what functions this boy is most likely to lose?
5. Why there were no reflexes in the lower limbs and abdomen? Why is his blood pressure low?
6. Over the few days later, his reflexes return in his lower limbs and becomes exaggerated. He is incontinent. Why this boy is hyper reflexive and incontinent?
7. According to his condition, what the nurse should assess for? Explain!
Explanation / Answer
1.
The location of a 12 year boy lacerations and bruises and his inability to rise led the doctors to diagnose a head, neck or back injury. His head and torso was immobilized inorder to prevent any further damage to the brain and spinal cord.
2.
The worsening neurological signs indicate a probable intracranial hemorrhage.
The blood oozing from the ruptured blood vessels will begin to compress boy s brain and increase his intracranial pressure. Boy's surgery will involve repair of the damaged vessel(s) and removal of the mass of clotted blood pressing on his brain.
3.Loss of motor and sensory function below the level of the nipples indicates a lesion at T4 will be expected to find spinal cord lesion.
4.boys nerve and motor functions are likely to be lost. His muscles will be paralyzed .
5.Boy's blood pressure Will be low due to the loss of sympathetic tone in his vasculature.
6.Boy's exaggerated reflexes are caused by damaged upper motor neuron axons in the spinal cord. These upper motor neurons normally inhibit spinal reflexes.
Boy is incontinent because there are no longer pathways to support voluntary control of bowel and bladder emptying.
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