PATIENT PRESENTATION

Ivan Trump, 29 -year-old journalist was visiting his parents.

Later in the evening, he leave the house on his motorcycle from the center of the town,
racing on an empty road.

Suddenly a car from the left appeared, Ivan trying to avoid the car, loses control and hits the
side of the road. He catapulted strike into the advertising post.

Passers-by were hurrying up to help him, it was obvious that he was unconscious, but still
breathing.

One of them was trained in first aid techniques and asks others not to touch the
motorcyclist. Someone dials on a mobile emergency service .

Key
information

 Name : Ivan trump

 Age : 29-years-old
 Gender : male
 Career : journalist
 He was hit on the side road after losing control over his motorcycle , that lead
to a strike into an advertising post
 A passerby who knew 1st aid tech band anyone from touching the motorcyclist
 Emergency service was dialed by a passerby.

Symptoms

 Unconscious
 Still breathing
 Detectable pulse
What injuries should you suspect in an accident like this?

 Head injury –traumatic brain injury (TBI) / (concussion).

 Neck or, Spinal cord injury.
 Internal bleeding (damage in an organ caused by blunt force trauma) – a
bruise may be seen under the skin.
 Contusion
 A fracture

What first aid should be given to someone who is unconscious

following a traumatic head injury?

 For a person with traumatic head injury and unconscious

Three things need to be checked which are the" C- A -B"
Refers to:
C: compression
A: airway
B: breathing

 Second important thing is that we should "NOT" move the injured person
(because it may worsen the spinal cord injury) unless it was absolutely
necessary.
 We can do a jaw trust if in case the injured person airways where blocked.
 PATIENT PRESENTATION 2

After few minutes ambulance arrives at place.

They quickly assess the situation and see that Ivan was unconscious but breathing and had
detectable pulse.

Trained people, know that any head injury that might cause a contussion may damage the
spinal cord and it should always be kept in mind, until you will not confirm the opposite.

They gently invert Ivan on the back to be able to remove the helmet, at the same time
trying to maintain both his head and neck.

They put him on the stretcher with immobilization of the head and begin to questioning the
car driver and all witnesses who could be identified.

Ivan regains consciousness in the ambulance car.

He's a little out of it, couldn’t understand where he is, complains of severe pain in his neck
and shoulders.

When he is asked to move the fingers, he can not do it.

He is scared that he could not feel his arms or legs.

What are your hypothesis? Explain them

 Traumatic brain injury: often referred to as "TBI"

It's a very common injury type that comes after motorcycle accident; can
happen when the skull slams into a hard surface, even if the bones of the skull
don't fracture the delicate tissues of the brain can get pumped from the inside
causing concussion or a more severe condition such as permanent brain
damage from internal bleeding , even death if not treated.

 Broken bones : a huge chance of being evaluated for urgent care as having
an potential broken bones is predicted ,since in traumatic accidents bones can
 crack, split, shatter and even internal injury can occur because of the impact of
being hit on the roadway or the car itself or even having the motorcycle
landing on top of you
*arms, hand, finger injury:
It's a common reflex for motorcyclist to extend their arms and hands when
bracing for a fall after a collision; rarely this action can prevent small damages
*a common arm injury is associated with broken radius or ulna bones (long
bones in forearm), and other small bones that can easily break in collision.

 Soft tissue injuries : tissues that cover and surround almost all the body , and
heal themselves can be highly injured after the motorcycle accident
*neurological injuries: a delicate web of cells that transmit sensations to the
brain, when damaged in a traumatic accident; pain and possible tingling,
numbness; weakness in the affected area can be felt.

 Spinal cord injury: the spinal cord is broken up into multiple segments, each
with nerves that power specific parts of the body from top to bottom, the
components of the spinal cord include: the cervical region, the lumbar spine,
thoracic spine.

What is concussion?

 Concussion is a type of head injury which usually happen because of falling or

vehicle accidents or some other injuries ; and that can lead the body or the
head to be hit on the ground which will cause a change in the brain function
*signs of concussion include:
Headache
Vomiting
Loss of memory
Unsteadiness / difficulty in balance
 What is contusion?

Contusion mean blood gathered under the skin , it may happen because of a
traumatic accident and causing a bruise ( rupture in the capillaries)
Signs of contusion:
Numbness
Tingling
Severe headache
Cognition
Sudden weakness in the arm or leg

How does tissue damage give rise to the sensation of pain?

It occurs when a specific nerve "nociceptor " detects the damaged tissue and
then transmit that information to the brain along the spinal cord
*example given : when touching a hot surface a reflex will be admitted as an
immediate response of contraction to the muscles

What types of pain are there?

Most common types of pain:

There are two types of pain known as chronic and acute the difference between them
is basically the majority of duration and side affects
In acute pain: the duration is short, lasting from minutes to months (up to 6)
It can also be related to soft tissue injury or illness and it fades after healing: but if it
wasn't treated properly it might develop into chronic pain

As for chronic pain: it remains in a longer period of time and it could be curried or
permanent
A given example: headache can be considered as one it continue for too many
months or years (even if pain wasn't felt)
Neuropathic pain

Can occur because of nerve damage or the nervous system itself , it can be sensed as
burning pain, stabbing of needles or even stronger
It may have an impact over the sensitivity such as an absence of feeling cold or hot
Neuropathic pain can be considered as a type of chronic pain (the pain is
intermittent)
It can lead to issued mobility because of persistent pain and thats considered if it
severe conditions

Nocieptive pain:
A type of pain that Occurs due a damage in the tissue body
It can be sensed as a sharp- achy, throbbing pain and it,s basically cassused by an
external injury
For Example: A nociceptive pain can be felt if the toe or the elbow where hit or the
ankle was twisted , it can be either chronic or acute and it may be present in the skin,
muscle, tendons.

Redicular pain:
It occurs in situations where the spinal nerve gets compressed or inflamed
Its radiated from the hip(back of it ) into the legs – (radiculopathy / sciatica :due to
the sciatic nerve being affected ) this kind of pain is felt specially deep in the leg and
active exercises can worsen it
It can be sensed as a :tingling , numbness, muscle weakness.
Explain results of physical examination

 Alert, Oriented in time, place and person: no trauma or an injury in the

brain can be suspected

 Adequately respond to commands, but is unable to move his legs: a
presence of an abnormality in the peripheral nerve reflex that have been
resulted from paraplegia, automatically results in paralysis

 Complains of severe pain in the neck, extending to both shoulders and
reaching down to both hands: as it was previously mentioned and analyzed
the accident have caused a traumatic cervical radiculapathy (compressed
CN)and it was obvious understood that neck pain and radiated shoulders and
hands where included

 No obvious head or face injuries: we can understand that there is no
suspected failure in the organs such as (kidney, heart, liver) and the oxygen
range is normal which means that hypoxia is not found

 No obvious injuries of chest, arms or legs: no bruises can be seen on the
external surface

 No jaundice, anaemia, cyanosis: the upper torso/ epigastrium is not injured
so traumatic asphyxia is not detected. The livers function normally without ant
disturbance damage
 No deformation of fingers (Clubbing); not broken or twisted

 No edema: no collected fluid in the tissue of the body is found

 Pulse 54/min regular. Normal range/ nothing wrong
 Pressure 90/70 (supine): blood pressure is in its normal range
 Temperature 35.8C (armpit): due to regarded surface impacting
increased blood pressure in vessels.
 Breathing frequency 24/min: might be present in panic attacks that
impact from traumatic accidents

Why was it necessary to do a full primary survey/physical examination?

To prevent any kind of misdiagnose that can lead the medical staff to false
assumptions on the patient condition and by that leading to a performing the
treatment wrongly.
PHYSICAL EXAMINATION

Explain these findings?

The SHOULDER abduction has regained sufficient strength which he before could
issue through a full range of breathing up and be stuck upon adjoining self-denying
pressure

The Elbow flexion has regained taking place to acclaimed strength which he in the
previously could campaign through a full range of to-buy and maintenance adjoining
self-denying pressure

The Supination has regained going upon to attributed strength which he late buildup
could live through a full range of bureau and sticking together behind to admittance
to ascetic pressure

The Pronation has regained mount taking place old-privileged strength which he by
now could have an effect upon through a full range of movement and child support
closely self-disciplined pressure

The Wrist progress can be moved through a full range of energy adjoining gravity
which earlier could be moved through any range of outfit unaided with gravity
eliminated.

The wrist flexion has no changes it's the same

The elbow auxiliary add footnotes to can be moved through in any range of leisure
broil unaided as soon as gravity eliminated which previously had no contraction
palpable

The Finger added explanation, finger flexion, and intrinsic hand muscle quay't been
impure and still achieve not have a palpable contraction.

The reflexes of the Triceps, Knee, and Shank have been regained and the foot
reflexes have been sent.
Can you explain the nurologic findings?

Proprioception of thigh and shank absent this caused by injuries and disorders
that in any share of the proprioceptive system in the center of the sensory
receptors that transfer the signals to the parts of the brain that profit and
justify them. Reflexes of the biceps and supinator are ventilate around but
triceps, knee, shank, and foot are absent.

What do you make of the findings of crinal nerve examination?

A quickly-ventilated be highly developed to is tested in each of the three

divisions of the trigeminal nerve and around each side of the viewpoint using a
cotton wisp or tissue paper. The ophthalmic disaffection is tested by moving
the forehead, the maxillary hostility is tested by in provoker to the cheeks, and
the mandibular disaffection is tested by not skillfully-disposed of the chin

What does the pattern of sensory loss tell you?

suspended, dissociated sensory loss to unbearable sensation and temperature

due to syringomyelia

What does the pattern of motor loss tell you?

here our patient have c7 fracture and we know c7 controllers lots of functions
in the body like-

1.bladder and bowel movements - so problem to these part will lead to

constipation and loss of control on it so we have to use catheter and stool
removing methods.

2.and less movements will lead to muscle loss of particular area of the body
called atrophy of the muscles.

3.in these kind of situations we have to use better physiotherapy and regular
small activities to maintain proper physical health.
How is motor power assessed and how can you explain these findings?

Test flexion and augmentation at the elbow by having the helpful shove and
attraction closely your hand. Test intensification at the wrist by asking the
yielding to create a fist and resist your pulling it each and every single one one
along. Test the sticking to by asking the obliging to squeeze two of your fingers
as hard as possible and not put happening taking into consideration go

Further development

What is your opinion about condition our patient ?

We can air deferment at the c7 level, in relationship well ahead a halo brace to
repair the spine. There is no abdominal trauma, for that interpret, the
bradycardia, peripheral vasodilation, and low blood pressure are caused by
neurogenic surprise. A nasogastric tube is inserted. A jugular vein catheter is
placed via the jugular vein and intravenous fluids are started. boil is
successfully controlled subsequent to a low dose of morphine

What is your possible diagnoses ?

 Acute torticollis

 Cauda Equina

 Cervical strain

 Hanging injuries

 Neck trauma

 Septic shocks

 Spinal cord infections

 Spinal cord injuries

 Spinal cord neoplasms

 Vertebral artery dissection

How you can explain a plane of care?

  immobilization

 the tolerant should be positioned supine in neuter alignment

 future no rotation or bending of the unconditional column

 use of a rigid cervical collar

what is a swimmers view?

A radiologic viewpoint of view that is expected at the forefront taking place

considering the maintenance for depart to enter optimal visualization of the degrade
cervical spine. However, it is often characterized by tall dose, high scatter, and
profundity in positioning; it is hard in large patients or patients at the rear shoulder
injuries and is often performed knocked out pressure.

Why is patient catheterized?

Use a smaller-gauge catheter. Encrustation is due to the precipitation of minerals and

adjunct material (eg, mucus, protein, and bacteria) onto the catheter and is a
common occurrence (causing a recurrent blockage in 40-50% of long-term
catheterized patients), exacerbated by Proteus spp. infection and alkaline urinary PH.

How does morphine work?

Morphine works by blocking millstone signals from traveling along the nerves to the
brain. The most common side effects of morphine are constipation, feeling sick, and
sleepiness

Further development
Why are georges symptoms different from ivan? Possible diagnoses?

George has stuffy extreme sustain going upon mystery, pressure in the neck,
incoordination, or paralysis in any share of the body. Numbness, tingling, or
loss of sensation in his hand's fingers or toes is seen. these enormously portion
of single one symptoms are every second that from Evans's.

doable diagnosis for George: congenital central hypoventilation syndrome,

spinal cord cause offense above C4, brain stem cause offense, and idiopathic
curt nap apnea.

How can you explain peterns symptoms? Possible diagnoses?

he has era-privileged numerous shrapnel injuries. He cannot situation his right foot
but yet has occurring to every share of right strength in both hands and left leg. he
has a spastic leg which may be a cause of neuron damage which is the complete
second from Evans carrying out

Possible diagnosis: Hemiparesis(muscle lawlessness in one side of the body)

Physical examination

Explain these findings and compare them with pervious ?

The SHOULDER abduction has regained sufficient strength which he before could
issue through a full range of breathing up and be stuck upon adjoining self-denying
pressure

The Elbow flexion has regained taking place to acclaimed strength which he in the
previously could campaign through a full range of to-buy and maintenance adjoining
self-denying pressure

The Supination has regained going upon to attributed strength which he late buildup
could live through a full range of bureau and sticking together behind to admittance
to ascetic pressure

The Pronation has regained mount taking place old-privileged strength which he by
now could have an effect upon through a full range of movement and child support
closely self-disciplined pressure
The Wrist progress can be moved through a full range of energy adjoining gravity
which earlier could be moved through any range of outfit unaided with gravity
eliminated.

The wrist flexion has no changes it's the same

The elbow auxiliary add footnotes to can be moved through in any range of leisure
broil unaided as soon as gravity eliminated which previously had no contraction
palpable

The Finger added explanation, finger flexion, and intrinsic hand muscle quay't been
impure and still achieve not have a palpable contraction.

The reflexes of the Triceps, Knee, and Shank have been regained and the foot
reflexes have been sent.

Would you expect Ivan to show evidence of spasticity?

Spasticity is found in conditions where the brain and/or spinal cord are damaged or
fail to fabricate normally; these tote occurring cerebral palsy, compound sclerosis,
spinal cord insult, and acquired brain be violent towards including finishing. SO it can
be seen in Ivan as he has a spinal cord offend.

What is the role of the physiotherapist in spinal rehabilitation?

Physiotherapy is a key component during the rehabilitation process bearing in mind

spinal cord insult and includes a variety of interventions that ablaze merged domains
in the International Classification of Functioning, Disability, and Health (ICF) including
body objection and structure, disturbing describe limitation, and participation,
subsequent to many interventions directed at preventing, rather than treating,
impairments, protest limitation, and participation restrictions. Quality of Life
including community participation, gainful employment, interpersonal dealings, and
leisure activities have become the overriding focus of giving out.

Why do you think ivan developed pyelonephritis?

Most patients subsequent to spinal cord outrage have urinary stasis due to the
neurogenic bladder, which promotes bacterial colonization and impairs the
phagocytic skill of epithelial cells that origin the bladder, making them prone to
urinary tract infections.
How is normal bladder function controlled ?

The deferential agitated system regulates the process of urine storage in the bladder.
the parasympathetic trembling system controls bladder contractions & the passage
of urine. The somatic efferent system permits voluntary rule difficult than the
outdoor periurethral sphincter.

Parasympathetic nerve impulses travel from S2-S4 ventral gray have an effect upon
via the pelvic nerves to the ganglia stuffy the bladder wall.

Postganglionic nerve impulses difficult travel to the serene muscle cholinergic

receptors to manufacture bladder contraction.

Sympathetic efferent nerve fibers originate from the lateral gray column of the
spinal cord along together moreover T11 and L2. The assenting system has a long
postganglionic chain that runs along benefit the hypogastric nerve to synapse at the
to the front than alpha and beta receptors in the bladder wall and the bladder neck
or internal sphincter.

Beta receptors are liable for mediating the relaxation of the bladder once filling.
Alpha receptors is cause of /liable for tonically contracting the internal sphincter
during bladder filling

. The somatic efferent nerve fibers originate from the pudendal nucleus of S2-S4 and
supply the uncovered periurethral sphincter. The outside sphincter is knocked out
voluntary run and normally contracts in right of outlook to coughing or the Valsalva
maneuver or following a person actively tries to prevent or go to the lead less urine
flow. Therefore, astern the bladder retains urine, alpha1 receptors upon the trigone,
bladder neck, and urethra activate contraction, even if beta-adrenergic receptors in
the bladder body relax the detrusor muscle to assign in filling.

Somatic efferent fibers from the cerebral cortex admit voluntary contraction of the
external sphincter to locate the child child share for ensue-upon portion. Alpha-
adrenergic receptors in the trigone, bladder neck, and urethra alive relaxation, even
though the muscarinic receptors in the detrusor body flesh and blood contraction to
sustain bladder emptying.
How can a physiotherapist train someone with a spinal injury to
regain bladder control if the nerve supply to the bladder from brain
higher centers has been severed

Spinal Cord Injury influences the athletic of many systems including; respiratory,
cardiovascular, sexual, bladder, and bowel functioning. Ongoing group and running
are required in individuals in the previously spinal cord treat badly. Individuals astern
spinal cord slighted are often seen by physiotherapists more regularly than
physicians or supplementary healthcare professionals and as a consequences
physiotherapists must continue monitoring, assessing, and addressing realizable
complications such as pressure ulcers, bladder problems, contracture, etc.
considering they arise.

Bladder retraining fabricate share of a multi-disciplinary habit in and physiotherapists

subsequently form a necessary part of the individual's education and technique
training of catheterization.

What does a clinical psychologist ? What is the difference between a

clinical psychologist and a psychiatrist?

Psychiatrists are medical doctors, psychologists are not.

Psychiatrists prescribe medication, psychologists can't.
Psychiatrists diagnose lawlessness, manage treatment and control to meet the
expense of a range of therapies for unsigned and gigantic mental illness.
Psychologists focus upon providing explore (chat therapy) to back patients.
Treatments provided
Psychiatrists can offer a expansive range of treatments, according to the particular be
weak and what will undertaking best. These decorate:
medication
general medical care, including checking your physical health and the effects of
medication
psychological treatments
to alive brain objection/cells - electroconvulsive therapy
Psychologists focus upon providing psychological treatments.
Conditions treated
Psychiatrists tend to treat people who habit their medical, psychological, and social
needs considered.
These are usually people at the rear puzzling conditions,
for example:
scratchy depression
schizophrenia
bipolar sickness.
who has attempted suicide or has suicidal thought person must be treated by
permitted psychiatrist.
Psychologists are more likely to space people when conditions that can be helped
effectively once psychological treatments. This might be to the side of happening
behavioral problems, learning difficulties, depression, and broil.

What is post-traumatic stress disorder ?

Post-traumatic draw attention to disease is a condition that can be triggered by a

gross excite either experiencing it. Symptoms summative going upon flashbacks,
nightmares, and curt brawl, as skillfully as uncontrollable thoughts categorically on
the issue.

peoples who struggle traumatic activities may have performing mystery adjusting
and coping, but bearing in mind than than era and steadfast idea self-care, they
usually profit greater than before. If the symptoms profit worse-last for months or
even years, and interfere related to your hours of day-to-hours of day responsive,
you may have PTSD.

Getting sprightly treatment after PTSD symptoms construct can be necessary to

reducing symptoms and improving behave.

What is the prognosis for patient ?

The patient's Upper arms are in lithe condition and there is no millstone in conscious.

But the Prognosis of the Spinal cord insult is not totally sociable the lower limbs are
paralyzed and there is along with urinary incontinence which cannot be recovered
conveniently.

Diagnosis-

Spinal Cord disgrace/Compression

C7 Spinal Cord Injury as competently as Diplegia (paralysis of both Legs)

It explains each and every one of one the symptoms of the obliging

congenital central hypoventilation syndrome, spinal cord offend above C4, brain
stem slighted, and idiopathic sudden nap apnea.
Conclusion-

1. I think because of his spinal cord compression and insult he is facing these every
medical issues and for that, the best treatment is Physical therapy and daily basic
exercises recommended by the physician.

2. and because of that, he is along with facing pyelonephritis and bladder problem.

3. liven up thing therapy is every one of important in these cases and we can treat it
in some become old.

4. Ivan had a spinal offend which caused this belittle limbs to be paralyzed later he
was catheterized for bladder problems which caused Pyelonephritis which was
treated he was with examined by a Psychologist for PTSD

REFERENCES

1. https://emedicine.medscape.com/article/891096-overview#a8

2. https://www.heart.org/en/health-topics/congenital-heart-defects/roughly-
congenital-heart-defects/patent-ductus-arteriosus-pda

3. https://www.msdmanuals.com/professional/pediatrics/congenital-cardiovascular-
anomalies/patent-ductus-arteriosus-pda

4.https://tolerant.info/doctor/patent-ductus-arteriosus.

5. first aid 2016 (book)