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PBL Group B, : :, Is a test laboratory analysis performed on a blood…

- - - - look, listen and feel movement of air
      - asses adequacy of the breathing process
      - listen to chest through auscultation
    - - examine for the life threatening haemorrhage
      - assess perfusion (level of consciusness, pulse rate, blood pressure, temperature, respiratory rate)
    - - Assess ability to speak in full sentence, juse phrases, single words or not at all
      - check consciousness
  - - - location of force and impaction
  - - - Vitamin K
      - Protamine sulfate
      - Fresh frozen plasma
      - Platelet transfusion
      - Coagulating concentrates
- - - - Site : Right side of temporal and parietal region (temporoparietal)
        Appearance: Hyperdense, large and convex lens-shaped lesion
      - Midline Shift : more than 15mm to the left
        Cause : when the pressure exerted by the extradural haematoma at the right side of temporoparietal region is powerful enough to push the entire brain off-center.
      - Extradural Haematoma
        
        Caused by bleeding of the middle meningeal arteries between the skull and dura.
        
        The patient has fracture of skull at the temporal site that caused laceration to the branches of the meningeal artery.
    - - What is CT scan?
        
        A computerized tomography scan that use computers and rotating X-ray machines to produce cross-sectional images of the body. All the images provide clearer and more details information than normal X-ray images. It detects soft tissues, blood vessels, and bones in various parts of the body.
        
        It is use particularly for diagnosing diseases and evaluating injuries.
        
        Only in the axial plane
      - How to determine left and right side
        Imagine looked at the patient from the patient’s foot.
        Physician’s left side will be the patient’s right side, and vice versa.
      - Hypodense - Black appearance : hollow structure filled with fluid
        
        Isodense - Grey appearance : soft tissue
        
        Hyperdense - White appearance : bony (calcified) surface
  - - - 110 bpm
        
        The patient heart rate is increased
        
        This may be due to the decreased in tissue perfusion in related to the large lacerations
        
        Heart pump faster to meet the demand of blood supply needed by tissue body
    - - 20 pm
        
        The respiratory rate is normal
        
        Showing that the patient may not have any difficulties in airway breathing
        
        He may also does not have any abnormalities in terms of his lung function
    - - 101/65 mmHg
        
        Patient blood pressure is greatly decreased
        
        Large laceration lead to significant decrease in blood volume
        
        Stroke volume decrease as well as total peripheral resistance
        
        Lead to reduction of blood pressure
    - - 37.6°C
        
        Patient temperature is slightly high but still consider as normal
        
        No fever but it is not confirm that the patient is free from any infection or not
        
        Fever not necessarily always associated with fever
    - - 9 - Moderate head injury
        
        The patient have a moderate level of GCS
        
        In terms of head trauma the patient is experiencing moderate head injury
        
        Originally patient had a normal score of GCS of 15 when being inspected at the site of accident
        
        after arriving at the emergency department patient level of GCS significantly dropped to 9
        
        Therefore this indicate that patient may have moderately injured his head
        
        Thus the patient needed to be seen as soon as possible by medical officer
- - - - wound characteristic
        
        Size
        
        Large laceration
        
        Shape
        
        Formed a curve
        
        Site
        
        The right side of the skull from just above the eyebrow and forehead extending back up to the parietal region
      - Exposed periosteum can be seen
      - No lost of skin. It is only separated
      - Appearance of arterial clamp on the edge of upper end (caudal) of the wound
    - - Laceration
        
        A messy looking wound caused by a tearing or crushing force. Doesn’t tend to bleed as much as incised wounds but often causes more damage to surrounding tissues.
      - Abrasion
        
        Caused by a scraping force or friction. Tends not to be very deep but can often contain many foreign bodies such as dirt
      - Puncture
        
        A deep wound caused by a sharp, stabbing object (i.e. a nail). May appear small from the outside but may damage deep tissues.
      - Incised wound
        
        A clean, straight cut caused by a sharp edge (i.e. a knife). Tends to bleed heavily as multiple vessels may be cut directly across.
      - Avulsion
        
        Caused by a tearing force in which tissue is torn away from its normal position. May bleed profusely depending on the size and location. The tissue is often completely detached.
      - Amputation
        
        The loss of a distinct body part such as a limb, finger, toe or ear. Often very severe with profuse bleeding. In the cases of limb loss this is a medical emergency.
    - - open or compound fracture
        
        -skin is not intact (skin break), fracture hematoma communicates with the exterior
        -needs urgent attention
        -principles : clean wound, remove all dead and devitalized and external tissue. Dirty wound must be left open for delayed primary suturing
        -supplementary treatment: antibiotic, prophylaxis against tetanus, precaution against ischemia( compartment syndrome), blood loss, infection (gas gangrene)
      - closed or simple fracture
        
        -fractures is within the confines of the soft tissue and has no connection of the exterior
- - - - Uses of blood test
    - - The patient’s white blood cell count is quite high
        
        This indicates that he might have an infection or any other underlying condition such as stress, allergy reaction, infection or even certain diseases like leukaemia. Which is why high white blood cell count needs to be further investigated.
        
        But in this patient’s case, his neutrophils, lymphocytes, and basophils are in normal range. But his monocytes and eosinophils are above the normal range. Which could indicates that he is having a chronic infection.
      - The patient’s Haemoglobin level is low which also explains why his red blood cells count is low as well.
        
        Low level of haemoglobin could be due to many factors such as nutritional deficiency, blood loss, bone marrow disease, kidney failure and also due to suppression of red blood cell synthesis.
        
        But in this case, the patient’s low Haemoglobin level could be due to blood loss because of the traumatic injury he suffered.
      - The hematocrit level is also low indicating that the patient is suffering from blood loss.
        
        It is because the patient was given IV Saline, but the hematocrit is still low.
        
        When patient is given saline it will only dilute and increase the blood volume but not the heamoglobin level.
  - - - INR test
        
        Measures the time for the blood to clot calculated from prothrombin time (PT)
        
        Used to monitor how well the anticoagulant is working to prevent blood clots
        
        To check for blood clotting problem, bleeding condition and liver functions
      - Blood INR ranges
        
        Normal human INR = 0.8-1.2
        
        Therapeutic INR = 2.0-3.0
        
        High risk group = 3.0-4.5
        
        Too high INR = blood clot slowly, too low INR = risk to develop blood clot
      - Based on the trigger:
        
        Patient's blood INR is higher than normal
        
        Indicates having blood clotting problem which requires him to take anticoagulant/ antiplatelet
        
        During the accident, the patient was having blood lost. It is because he has low blood clotting tendency.