Trauma and Post-OP Management: Scenario 2

by Stuart Enoch, PhD

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    00:01 Okay, head injury this comes up, pretty much every scenario, every exam will have something on head injury.

    00:08 So standard scenario, bruising of the left side of face, faded the hemi-pelvis, parallel region, drop in GCS, high potency.

    00:21 Okay? What are causes of reduced GCS? One is head injury, fine.

    00:28 Anything else? Shock? Yeah, very good.

    00:32 I truly, did morphine you mean.

    00:35 Okay? Yeah, take that.

    00:38 Hypoxia.

    00:41 Alcohol? Yeah, you're right.

    00:44 That will be there, but these are the common ones, the important ones, head injury, subdural, extradural, shock, hypoxia, due to respiratory depression, due to a head injury, facial fractures, pneumothorax, haemothorax, flail chest, your opiates as well, fine.

    01:02 Why is a patient drowsy in an any situation, in an any? Alcohol.

    01:09 Okay.

    01:10 Drugs, very good.

    01:11 So, hypoglycemia is a common stone then alcohol, drugs and again opiate overdose.

    01:17 Okay? Now, make sure that in the exam, always remember hypoxia and hypoglycemia.

    01:25 Sometimes, they ask what is the single most common thing? What is the most..

    01:28 What is the most likely cause of confusion? Certainly, we know we always think of slightly more complex things but they're asking hypoglycemia, it is so common.

    01:37 In a post operative patient as well, hypoglycemia is one of the commonest cause of confusion.

    01:44 Okay, indications for CT in an adult.

    01:47 So starting indications, that's based on the NICE guidelines and this is what is asked the exam as well.

    01:56 Pretty much logical things, I don't think there is anything which is not logical, you know, if you just look at it, you'll understand, there's nothing you have missed.

    02:19 Okay.

    02:26 Okay, the question here normally what is asked is, what is the most appropriate investigation in a 60 year old or 70 year old patient presenting with head injury, but got a GCS of around 14, 15? Would you go for a skull x-ray or for a CT? That's where the you need to be careful.

    02:47 Elderly patient reduced GCS and if they have any, anything, any of these, coagulopathy or even one of these features, always go for CT.

    03:01 Because your skull x-ray like so it's probably not going to show anything.

    03:04 Okay? Symptoms of raised ICP? Okay, headache.

    03:15 Yeah, what's it called? Hypertension bradycardia.

    03:22 So, headache, nausea, vomiting, reduced level of consciousness, and then your question reflects, but that will be at a later stage.

    About the Lecture

    The lecture Trauma and Post-OP Management: Scenario 2 by Stuart Enoch, PhD is from the course Trauma and Post-OP Management.

    Author of lecture Trauma and Post-OP Management: Scenario 2

     Stuart Enoch, PhD

    Stuart Enoch, PhD

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