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Original Question

CASE A 68-year-old male presents to ambulance crew through emergency call after falling from his bicycle at an unknown speed. Patient was cycling on quiet country road when he fell from his bicycle. He was not wearing a helmet at the time. His friend found him semi-conscious on the road. He was placed sitting in a car that stopped to help where he was still sitting on arrival of ambulance crew O2 @15lpm commenced via non-rebreather mask. Cervical collar applied. Patient extricated from vehicle via rapid extrication, as vomiting profusely, unable to manage airway adequately. Secured to longboard, transferred to ambulance. Suction provided as patient’s level of consciousness began to deteriorate, snoring respirations evident. En-route, GCS reduced to 3/15, patient unresponsive. OPA inserted, not tolerated. Vomiting profusely, incontinent of urine, decorticate posturing evident. Transported in right lateral position to allow for airway management. On arrival at ED patient exhibiting decerebrate posturing. Specific Questions: Discuss the patient triaged or category. Discuss the Glasgow Coma Scale. What are the signs and symptoms of severe traumatic head injury? What are the immediate nursing interventions that need to be done in this case? Brought directly to Resus room. Aggressive airway management commenced. Patient sedated, paralysed and intubated (RSI). Urinary catheter inserted. Blood tests taken. Specific Questions: What are the diagnostic tests that need to be conducted and what are the nursing considerations? Clinical Findings: No overt head injury evident. Query cause of fall. Sent for CT Brain. Large hypertensive bleed found on scan. Patient sent to ICU on ventilator. Specific Questions: What are the basic clinical findings in the CT-Scan? What are the nursing management for severe traumatic brain injury?

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