In the case study provided, the 82 year old unconscious female needs an assessment and a differential diagnosis completed so that the paramedics know how to treat and to determine if the patient is time or transport critical. A differential diagnosis comes from the paramedics’ education and the patient’s history, current vitals signs, and pertinent knowledge gained from those at the scene. The paramedic must, after the differential diagnosis, have an understanding of the pathophysiological process and how this affects the patient.
The patient has an Acquired Brain Injury (ABI), which is an injury occurring after birth (State Government of Victoria, 2013). The patient also has traumatic brain injury (TBI), which is caused by a physical force resulting in damage to the brain. One aspect of finding a differential diagnosis is an understanding of the mechanism and pattern of injury (MOI/POI). When looking at brain injuries the MOI/POI can be separated into two parts, primary and secondary injuries. Primary injury is the one that occurs at that moment of impact, i.e. the table that causes a visible hematoma (Rosenfeld, 2012). The secondary injury is the cascade of events and medical conditions, which can aggravate the primary injury (Hughes & Cruickshank, 2011). In this patients case it is the chronic subdural haematoma that has caused secondary conditions, such as Cushing reflex and this has caused the patient to become unconscious.
Looking at the patients’ vital signs they are steadily deteriorating, and are worrying for an 82 year old female. The patients’ heart rate starts low but in the normal range however in the time of 15 minutes it drops to 54bpm, which is within the range of bradicardia (Curtis, Ramsden & Lord, 2011). This is a concerning sign because if the patients heart rate is to continue to drop, the patent may slip into cardiac arrest. The blood pressure of the patient is considered hypertensive, this is alarming because within the space of 15 minutes the patients blood pressure goes from 160/100 which can be borderline acceptable, but then jumps to 190/100 is precarious for this patient however the significant jump may be due to the patients underlying condition of hypertension (Curtis, Ramsden & Lord, 2011). The respiratory rate indicates that there is a concern for the patients’ airway, and their efficiency of their breathing, which means that the perfusion of oxygen around the body especially to the brain is impaired which is shown in the decrease in SpO2 readings. The patients pupilary response are concerning with the pupils fixed, uneven and dilated (Professional Health Systems, 2014)
Using this information a differential diagnosis of the patient can be made. The patient has a chronic subdural haematoma, which has developed from the primary injury. This has lead to the patient developing the Cushing reflex, which is a later indication that the patient is going to develop a brain hernaition (Curtis, Ramsden & Lord, 2011). ...
