Following a fall two weeks ago in which Betty hit her head on a table, Betty sustained a 4cm haematoma. The fall appears to have resulted in a traumatic brain injury (TBI); given the information it would appear as though Betty may have an external haematoma, cerebral contusion and intracranial haemorrhage.
Injuries related to falls costs Australia's health care system more than any other injury. It is expected that over 25% of Australia's elderly population (65 and over) are likely to have a fall. Falls account for over 50% of traumatic brain injuries in people over 65 (NSW Government; Population Health, 2011). The number of risk factors for a fall increases with age, therefore making the elderly population more susceptible to having a fall (Thompson, McCormick, & Kagan, 2006). In Betty's case the mechanism of injury is a vertical deceleration. Betty tripped on a mat and hit her head on a table, as she hit her head this would provide the coup mechanism causing the brain to strike the front of the skull, the countercoup motion is the motion of the brain being thrust into the back of the skull (Medicallegalart, 2011).
The pattern of injury refers to the pathophysiological changes that occur after the injury. Given Betty's deterioration in the fifteen minutes between the initial vital sign survey and the second, in light of Cushing's reflex, it is possible that Betty's fall has caused a cerebral haematoma and her intracranial pressure (ICP) is rising. Cushing's reflex is the hypothalamic response to an increase in intracranial pressure, and increase in intracranial pressure causes poor perfusion and brain ischemia, resulting in an altered level of consciousness. The reflex results in the clinical symptoms of Cushing's triad, which is made up of three elements, hypertension and a widening between the systolic and diastolic blood pressures, bradycardia and irregular breathing (Liferidge, 2014).
The provisional diagnosis points towards a subdural haematoma or an intra-cerebral haematoma. Given her age and the mechanism of injury it is likely to be a chronic subdural haematoma, as the onset of symptoms was gradual over a two week period. It is more likely to be a chronic subdural haematoma rather than a sub-acute haematoma, as chronic subdural haematomas are more common among elderly patients, and they are often tolerated as elderly brains are generally smaller in size due to part of the natural aging process in which brain atrophy occurs (Curtis, Ramsden, & Lord, 2011, p. 1176). The chronic subdural haematoma may have resulted in brain herniation. It could possibly be an intra-cerebral haematoma due to her anti-hypertensive medication, as high blood pressure can cause a haemorrhagic stroke, but given her earlier fall it is most likely a traumatic brain injury (Sanders, Quick, Lewis & McKenna, 2012, p. 1170).
Betty's fall could have been caused by a number of reasons, her medications Avapro HCT and Anginine are contraindicated when taken together as...