Case 310

Case 310

Medical history

A 66 year-old male patient is admitted unconscious to a trauma center after falling from a 3 meter height. His primary examination reveals: patent airway, symetric thoracic expansibility, non-laborious breathing, normal breath sounds, 22 respiratory incursions per minute, hemodynamic stability, 8 points in the Glasgow Coma Scale (GCS), isocoric non-photoreactive pupils and right otorrhagia. A non-contrast-enhanced head computed tomography (CT) scan is urgently acquired.

Image 1: Non-contrast-enhanced head computed tomography (CT), axial section, level of the occipital horns of the lateral ventricles, brain window.

Image 2: Non-contrast-enhanced head computed tomography (CT), axial section, level of the frontal horns of the lateral ventricles, brain window.

Image 3: Non-contrast-enhanced head computed tomography (CT), coronal reconstruction, level of the mastoid parts of the temporal bones, bone window.

Question:

Taking into account the clinical scenario and the CT head scan results, what are the next best steps in this patients management?

Test question

[Medical Residency 2017: Faculty of Medical Sciences of Unicamp – SP]

A 7 year-old male patient is brought unconscious and with spontaneous breathing to the Emergency Department by Emergency Medical Services after having been run over and thrown a distance of approximately 10 meters. Physical examination: HR = 140 bpm; RR = 33 ripm; capillary refill time = 3 seconds. Head: frontal contusion. Neurological examination: the patient emits incomprehensible sounds, localizes pain and doest not open his eyes in response to painful stimuli. 


Question:
The patient’s conscious state and the best next step in airway management are:

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