[Verified Answer]: JK and traumatic brain injury Consider the…

JK and traumatic brain injury Consider the person. Last evening JK went out to the local pub with a few friends from university. There was a new band playing at the pub and Joss was especially excited to be going. To save money Joss and his friends met up at a friend’s house for ‘pre-drinks’. During this time Joss drank around four full strength beers. JK is an 18-year-old university student who lives on-campus as his parents reside in another state. Joss is studying engineering and enjoys university life. He has a part-time job working at the local supermarket for 15 hours each week. When JK his friends arrived at the pub, they headed straight for the bar to get another beer. They were having a great night; the music was good, and the pub was busy. Later in the evening JK started talking to a friendly young woman. Shortly after he was approached by a man who aggressively accused Joss of talking to his girlfriend. JK apologised and returned to his group of friends. Approximately an hour later JK said goodbye to his friends as he had decided to head home. As JK was leaving the pub, he was followed out by the man who had earlier confronted him. The man was still verbally aggressive and ended up pushing JK to the ground, resulting in him hitting his head on the cement curb of the road. The security guard saw this incident and intervened. Whilst JK was not punched, he did sustain a laceration to the back of his head. The security guard noticed quite a bit of bleeding and rang an ambulance. Collect cues. Paramedics When the ambulance arrived, Joss had a GCS of 15 and could recall the whole incident. Joss appeared to have no other injuries. The paramedics undertook vital signs which they stated were ‘normal’ and applied a bandage to Joss’s head wound. The security guard stated that he ‘didn’t think Joss lost consciousness’. Emergency Department: • 18-year-old male, brought in by ambulance following an alleged altercation where patient struck head on road curb at 2300 hrs. • Patient denies loss of consciousness but unable to recall all details of the incident. Patient appears alert but teary and takes a couple of moments to answer questions. • On examination, 4cm occipital laceration noted with slow ooze from wound. Dressing insitu. Vital signs and GCS recorded at 2325 hrs as per chart. No other obvious injuries. • Patient denies drug use, states has had approximately ‘five beers since 7pm’. Breath alcohol taken at 2330 hours 0.06%. • Patient reports pain to be 5/10 at occipital region, no analgesia taken prior to presentation. • Patient states they are usually fit and well. Assessment and investigation data: Past medical history: Childhood asthma, up to date with immunisations (last tetanus 12 months ago). Not on any medications and no known allergies. Vital signs: RR: 18 breaths per minute SpO2: 99% on room air BP: 141/88 mmHg (MAP 106 mmHg) HR: 90 bpm Temp: 36oC tympanic Neurological assessment: GCS: eyes 4; verbal 4; motor 6 (14) Pupils: PERRLA – 4+ response Limb strength: bilateral upper and lower limbs – normal power Computerised tomography (CT scan) Modality: CT Body Part: NEURO Description: CT Brain and C-Spine Performed Date: 25/3/Year Time: 0015 Final Report CT BRAIN AND C-SPINE CLINICAL NOTES: Witnessed awkward fall after physical altercation, head knock with no reported loss of consciousness. Findings: A non- contrast CT has been acquired. No acute intracranial abnormality is seen. There is no intra or extra-axial haemorrhage noted. There is no cerebral oedema, midline shift or hydrocephalus. Unremarkable posterior fossa structures. No skull fractures are seen. No obvious fractures from C1 to T2. IMPRESSION: No acute abnormality on the examination. Metabolic assessment: Blood Glucose Level: peripheral 6.2 mmol/L Process information: interpret, relate, and infer, and predict based on existing and new knowledge. 1. Identify the types of cells, tissues, and structures that may have been damaged by the head strike. 2. What is meant by primary injury in this context? 3. Explain the principle of coup / contrecoup contusion injuries. 4. Discuss the process that follows damage to tissue anywhere in the body. 5. Discuss why this consequence of damaged tissue is particularly problematic inside the skull. 6. Determine how cerebral perfusion pressure (CPP) is related to intracranial pressure (ICP) and MAP. 7. What is meant by secondary injury in this context? Answer this question by considering the components that give rise to ICP and the relationship of ICP to CPP. Collect Cues: JK was admitted to hospital for overnight observation. 1/24 (hourly) vital signs and neurological observations are requested. JK has some paracetamol for pain and can fall asleep once he reaches the ward. Refer to the ADDS and neurological charts on the next pages to consider Joss’s clinical data from first presentation