While running, a 16-year-old female basketball player, Kelsey Smith falls and hi
ID: 79905 • Letter: W
Question
While running, a 16-year-old female basketball player, Kelsey Smith falls and hits her head on the gym floor while at high school basketball practice. She does not lose consciousness but is dizzy, develops a headache, and nausea. She is not able to finish practice. Her parents bring her to the Emergency Room where you are working.
1. What questions do you want to ask?
2. What are possible pathophysiologies that could be happening to Kelsey? That is—brainstorm as many pathophysiologies as possible for her—and list them here
3. After developing a list of pathophysiologies, sort them and rank them numerically. Explain your rationales for your choices to be ranked as you chose them.
4. Test your hypothesis: List the diagnostic tests you would order to confirm or rule out the number one ranked choice.
5. What are the treatments and activity restrictions you recommend for Kelsey?
Explanation / Answer
1) In patients with non-penetrating traumatic injuries, the questions to be asked initially are wheather the patient has headache, vomiting, loss of conciousness, post-traumatic seizure, deficits in short term memory and any bleeding abnormality.
2) The posible pathophysiologies that could happen to Kelsey include, skull fracture, cerebral concussion, intracerebral haemorrhage, subarachnoid haemorrhage, subdural haematoma, extradural haematoma, intraventricular haemorrhage, diffuse axonal injury and mild traumatic brain injury.
3)
4) The initial assessment of individuals with head injuries is done by the Glasgow Coma Scale (GCS). The questions asked will fall into three main categories, motor, verbal, and eye scores. It is done within the first 6-8 hours after injury and is considered to be a predictor of the patient's overall outcome. The GCS score is often used to categorize the severity of head injury into mild (15-13), moderate (12-9), or severe (8 or less).
Imaging tests are commonly used to diagnose head injuries. CT scan for finding fractures, evidence of bleeding and clotting, brain swelling, and any other structural damage. MRI scan will offer more detailed view of the brain.
In cerebral concussion, GCS is normal. CT will show single or multiple parenchymal lesions, contusions commonly found on the frontal and temporal poles. In MRI, haemorrhagic contusions are hyperdense on T1-weighted imaging and hypodense on T2-weighted imaging, non-haemorrhagic lesions are hypodense on T1-weighted imaging and hyperdense on T2 imaging.
5) Drugs to limit secondary damage to brain includes diuretics and anti-seizure drugs. Activity restrictions include both physical rest and cognitive rest. Physical rest includes no sports, no weight training, no sexual activity, no leisure activities such as bike riding and skateboarding. Cognitive rest includes time off from school or work, reduced homework, limited reading, limiting visually stimulating activities, no trips and increased rest and sleep.
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