Clinical Case Studies Peripheral Nervous System William Hancock, a 44-year-old male, was a passenger on the bus involved in the accident on Route 91. When emergency personnel arrived on the scene, they found Mr. Hancock unconscious, but with stable vital signs. As paramedics placed him on a backboard to stabilize his head, neck, and back, they noted watery blood leaking from his right ear. In the hospital, Mr. Hancock regained consciousness and was treated for deep lacerations on his scalp and face. Head CT scans revealed both longitudinal and transverse fractures of the right petrous temporal and sphenoid bones that extended through the foramen rotundum and foramen ovale. The following observations were recorded on Mr. Hancock's chart on admission: • Complete loss of hearing in the right ear. • Paresthesia (sensation of "pins and needles") at the right corner of the mouth, extending to the lower lip and chin. • Numbness of the right upper lip, lower eyelid, and cheek. Right eye turned slightly inward when looking straight ahead. Diplopia (double vision), particularly when looking to the right.

Phlebotomy Essentials
6th Edition
ISBN:9781451194524
Author:Ruth McCall, Cathee M. Tankersley MT(ASCP)
Publisher:Ruth McCall, Cathee M. Tankersley MT(ASCP)
Chapter1: Phlebotomy: Past And Present And The Healthcare Setting
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1. In addition to blood, which fluid was leaking from Mr. Hancock’s right ear? Which structures must have been damaged to allow this to happen? Why would this lead Mr. Hancock’s doctors to give him antibiotics? Why was the head of his bed elevated? 2. Each of the four observations on Mr. Hancock’s chart indicates damage to a cranial nerve. Identify each cranial nerve involved. If applicable, identify which specific branch of that nerve is involved. Mr. Hancock was given a course of antibiotics, the head of his bed was elevated by 30°, and he was placed under close observation. After 24 hours, doctors noted that the right side of Mr. Hancock’s face showed signs of drooping, with incomplete eye closure and asymmetric facial expressions. Mr. Hancock’s right eye showed minimal tear production. The weakness and asymmetry on the right side of his face began to subside after a few days, and the leak of fluid from his ear stopped, but he continued to complain of paresthesia, diplopia, and an inability to hear with his right ear. 3. The observations after 24 hours suggest that yet another cranial nerve has been damaged. Which one? How can you explain the lack of tear production in the right eye? Special Senses: When emergency personnel arrived on the scene of the bus crash,  they found Brian Rhen, 42, sitting on the side of the road holding his head in his hands. He complained of a severe headache and nausea, 

Clinical Case Studies
Peripheral Nervous System
William Hancock, a 44-year-old male, was a
passenger on the bus involved in the accident on
Route 91. When emergency personnel arrived on
the scene, they found Mr. Hancock unconscious,
but with stable vital signs. As paramedics placed
him on a backboard to stabilize his head, neck,
and back, they noted watery blood leaking from
his right ear. In the hospital, Mr. Hancock regained consciousness and was
treated for deep lacerations on his scalp and face. Head CT scans revealed
both longitudinal and transverse fractures of the right petrous temporal
and sphenoid bones that extended through the foramen rotundum and
foramen ovale.
The following observations were recorded on Mr. Hancock's chart on
admission:
• Complete loss of hearing in the right ear.
• Paresthesia (sensation of "pins and needles") at the right corner of the
mouth, extending to the lower lip and chin.
• Numbness of the right upper lip, lower eyelid, and cheek.
Right eye turned slightly inward when looking straight ahead. Diplopia
(double vision), particularly when looking to the right.
Transcribed Image Text:Clinical Case Studies Peripheral Nervous System William Hancock, a 44-year-old male, was a passenger on the bus involved in the accident on Route 91. When emergency personnel arrived on the scene, they found Mr. Hancock unconscious, but with stable vital signs. As paramedics placed him on a backboard to stabilize his head, neck, and back, they noted watery blood leaking from his right ear. In the hospital, Mr. Hancock regained consciousness and was treated for deep lacerations on his scalp and face. Head CT scans revealed both longitudinal and transverse fractures of the right petrous temporal and sphenoid bones that extended through the foramen rotundum and foramen ovale. The following observations were recorded on Mr. Hancock's chart on admission: • Complete loss of hearing in the right ear. • Paresthesia (sensation of "pins and needles") at the right corner of the mouth, extending to the lower lip and chin. • Numbness of the right upper lip, lower eyelid, and cheek. Right eye turned slightly inward when looking straight ahead. Diplopia (double vision), particularly when looking to the right.
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