MedBugs: SAQ #209

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Case: Epidural haematoma with rural deterioration

A previously well 35-year-old man presents to a rural ED 90 km from the nearest trauma centre following an isolated head injury. He is alert but amnestic, repeatedly asking what happened. Vitals: HR 90 BP 130/85 SpO₂ 98% RA T 36.5 GCS 15. CT brain and C-spine are performed.

1. List the four most important CT findings. 4 marks

Shortly after the CT scan, the patient deteriorates. His GCS falls to 10 (E2V3M5). His pupils remain equal.

2. State five most important peri-intubation considerations specific to this patient after deterioration to GCS 10. 5 marks

Under your expert care, the intubation progresses uneventfully with appropriate postintubation care commenced.

3. List three important considerations for the patient’s ongoing management post-intubation. 3 marks

Twenty minutes later, the patient becomes bradycardic (HR 54) and hypertensive (BP 200/110). His left pupil becomes dilated.

4. State six immediate actions when the patient becomes bradycardic, hypertensive and develops a unilateral dilated pupil. 6 marks

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Case: Epidural haematoma with rural deterioration

1. List the four most important CT findings. 4 marks

2. State five most important peri-intubation considerations specific to this patient after deterioration to GCS 10. 5 marks

3. List three important considerations for the patient’s ongoing management post-intubation. 3 marks

4. State six immediate actions when the patient becomes bradycardic, hypertensive and develops a unilateral dilated pupil. 6 marks

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