A 32-year-old male Joseph Rooster was brought

A 32-year-old male Joseph Rooster was brought in by ambulance to the Emergency Department after being witnessed to have a high speed motorcycle accident. The patient was not wearing a helmet and was unconscious with a GCS of 3/15 (E1, V1, M1) when the paramedics arrived. The handover from the paramedics is as follows: Paramedic handover M: 32-year-old male, rider of a motorcycle was involved in a crash estimated at 80km/h. Patient was not wearing a helmet. I: Closed head injury GCS 3/15. Deformity to right lower limb. Abrasions to trunk, and both arms. S: Obs on arrival RR 9, SpO2 85% on RA, HR 50, BP 140/50, GCS 3/15, Pupils 4mm and sluggish, T36.0, BSL 7.2mmol/L T: Patient intubated on scene, a cannula was inserted into the left cubital fossa. A hard cervical collar was applied. During the primary survey chest and pelvis x-rays were performed and were normal. The patient was given a tetanus booster and 2g of IV Cephazolin. A CT scan of the head, neck, chest and pelvis was attended which demonstrated an acute subdural haematoma in the frontal lobe, there was no evidence of midline shift. No cervical spine, or other spinal pathology was identified. An X-ray of the right upper limb revealed a communited fracture of the distal radius and ulna. The patient was referred to Neurosurgery. The Neurosurgical registrar recommended that the patient be transferred to ICU, not for surgery currently and to sit the patient up to 30 degrees and perform modified log rolls. The patient was changed to a Philadelphia collar. An Indwelling Catheter was also inserted. The orthopaedic registrar reviews Joseph in ED and reduces Joseph’s arm and applies a backslab. Joseph will require an Open Reduction Internal Fixation when he is more stable. What are your thoughts on the following question How would you classify the severity of Joseph’s brain injury? Why? Why did the paramedics initiate spinal precautions? Why does the patient require a Philadelphia collar when the CT scan was normal? What is secondary brain injury? What are some nursing interventions that we can implement to reduce the patients intracranial pressure?

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