 |  patient unconscious after trauma
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| YES |
infliximab, miha152, abissun, DrS, tahir, frontal, hopdoc, lidia, anothergoljanfan, diyamirzah, indira_9, study_ing, locodino |
13 |
87% |
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msyamp |
1 |
7% |
| NO |
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0 |
0% |
| Author | 12 Posts |
docofthebigapple
Forum Senior
Topics: 23
Posts: 174
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Okay here's the question
A middleaged man is brought to you in the ER after he sustains a fall from his second floor balcony in an attemped suicide. On arrival, you see the patient is unconscious and is bleeding from the nose. Initial survey also shows an open tibial fracture in right leg. You check his pupils which are of equal size and are responsive to penlight. The patients opens his eyes and attempts to move all limbs on a very painful stimuli that you give him by pinching his ear. He also makes a muffled sound at this time.
After initial Cardio-respiratory resuscitaion, your next smart move should be
1. Send patient for CT head
2. Send him for X-Ray right leg
3. Send him for X-Ray Spine
4. Try a lumber puncture
5. Send for X-ray head.
Please share your rationale after giving your answer.
Thank you.
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| chemamr
Moderator and PGY1
Topics: 703
Posts: 4,441
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mmm, we donīt know even the vital signs. If number 3 is a cervical spine XR, maybe that would be the correct answer, because itīs one of the XRays you must order in all trauma cases like this one. I guess, after that and when pt is stable you could order a CT head.
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| msyamp
Forum Fanatic
Topics: 60
Posts: 1,462
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because he has bleeding from nose. it can be a base of skul fracture too. do a CT.
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| chemamr
Moderator and PGY1
Topics: 703
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yes, he needs a CT, but after the cervical spine XR, do you agree with it?
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| achilles
Forum Guru
Topics: 85
Posts: 1,201
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cant we send the patient directly for CT ( once the patient has been stabilized ) and extend the CT to include the cervical spine and not need the xray spine at all.
the CT is more sensitive too though. but i am not sure. but this is what i would pick
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| chemamr
Moderator and PGY1
Topics: 703
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we should wait for the given answer. I hope docofthebigapple has it
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| DrS
Forum Elite
Topics: 32
Posts: 338
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3. Send him for X-Ray Spine
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| stepkiller
Forum Junior
Topics: 0
Posts: 36
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what would be the right answer??
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| docofthebigapple
Forum Senior
Topics: 23
Posts: 174
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hi everybody, thanks for your responses. I will share my rationale and the explaination that was given for this answer.
In this question my confusion narrowed down to whether we should send the patient for a CT head or an Xray cervical spine.
Now that patient has head trauma and is unconscious and is also bleeding from the nose. A very serious trauma situation. Fracture of base of skull is suspected. But his pupils are bilaterally symetric and are responsive to light which indicated that bleeding is not intracranial.
Also we realise that is a big trauma and we should also check for cervical spine fractures. But what to do first was my dillemma. And i had picked Ct head
But the answer provided was C.
And the explanation given was that nearly 5-10% trauma with head injury patients have fracture cervical spine and it should be the first thing to be checked before mobilising the patient. Now the clinical examination for assessing frature here is not very reliable, so an Xray should be done which is nearly 90% sensetive. After a fracture is ruled out AND the patient has been stabilised, can we send the patient for CT head.
Tell me what do you think. Further discussions are welcome.
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| chemamr
Moderator and PGY1
Topics: 703
Posts: 4,441
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i agree with the explanation . 1st cervical spine XR, after that, CT (of these answers, of course, because 1st step overall is the ABC based on ACLS).
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| stepkiller
Forum Junior
Topics: 0
Posts: 36
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hmmm sounds fine. ans is spine
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| achilles
Forum Guru
Topics: 85
Posts: 1,201
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i just looked up the kaplan notes and it says that every patient with a severe head trauma and with # base of skull and who was unconcious must go for a CT scan but injury to the spine must also be ruled out.
X-ray cervical spine must be done or if CT head was done , it can be extended to include the neck. in the question the option is only of CT head and not CT head that includes cervical spine so i too agree with the answer been C and thats x-ray cervical spine.
this forum is gr8 . it really helps me learn.thanks guys.
Edited by achilles on 02/23/06 - 09:14 AM
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