Last evening Zac went out to the local pub with a few friends from university. There was a new band playing at the pub and Zac was especially excited to be going. To save money Zac and his friends met up at a friend’s house for ‘pre-drinks’. During this time Zac drank around four full strength beers. Zac Smyth is 18 year old university student who lives on-campus as his parents reside in another state. Zac is studying engineering and enjoys university life. Zac has a part-time job working at the local supermarket for 15 hours each week. Zac has no immediate family in the state but he has a friend of his parents that he sees from time to time. Zac usually goes home to his family during his breaks but due to his work commitments, Zac has not seen his mum, dad and younger brother for the past 4 months. When Zac and his friends arrived at the pub, they headed straight for the bar to get another beer. Zac and his friends were having a great night, the music was good and the pub was busy. Later in the evening Zac started talking to a friendly young woman. Shortly after Zac was approached by a man who aggressively accused Zac of talking to his girlfriend. Zac apologised and returned to his group of friends. Approximately an hour later Zac said goodbye to his friends as he decided to head home. As Zac was leaving the pub he was followed out by the man who had earlier confronted him. The man was still verbally aggressive and ended up pushing Zac to the ground, resulting in Zac hitting his head on the cement curb of the road. The security guard saw this incident and intervened. Whilst Zac was not punched, he did sustain a laceration to the back of his head. The security guard noticed quite a bit of bleeding and rang an ambulance. collect cues: paramedics: When the ambulance arrived, Zac had a GCS of 15 and could recall the whole incident. Zac appeared to have no other injuries. The paramedics undertook vital signs which they stated were ‘normal’ and applied a bandage to Zac’s head wound. The security guard stated that he ‘didn’t think Zac lost consciousness’. triage: 18 year old male, brought in by ambulance following an alleged altercation where patient struck head on road curb at 2300 hrs. Patient is denies loss of consciousness but unable to recall all events. Patient appears alert but teary and takes a couple of moments to answer questions. On examination, 4cm occipital laceration noted with slow ooze from wound. Dressing insitu. Vital signs and GCS recorded at 2325 hrs as per chart. No other obvious injuries. Patient denies drug use, states has had approximately ‘five beers since 7pm’. Breath alcohol taken at 2330 hours 0.06%. Patient reports pain to be 5/10 at occipital region, no analgesia taken prior to presentation. Patient states is usually fit and well. past medical history: Childhood asthma, up-to-date with immunisations (last tetanus 12 months ago).Not on any medications and no known allergies. QUESTION: A very important intervention for any deteriorating patient is to increase the frequency of observations undertaken. If Zac were to significantly deteriorate, what trend in his respiratory function might be observed? Explain the pathophysiological mechanisms which would cause these changes in details.
Last evening Zac went out to the local pub with a few friends from university. There was a new band playing at the pub and Zac was especially excited to be going. To save money Zac and his friends met up at a friend’s house for ‘pre-drinks’. During this time Zac drank around four full strength beers. Zac Smyth is 18 year old university student who lives on-campus as his parents reside in another state. Zac is studying engineering and enjoys university life. Zac has a part-time job working at the local supermarket for 15 hours each week. Zac has no immediate family in the state but he has a friend of his parents that he sees from time to time. Zac usually goes home to his family during his breaks but due to his work commitments, Zac has not seen his mum, dad and younger brother for the past 4 months.
When Zac and his friends arrived at the pub, they headed straight for the bar to get another beer. Zac and his friends were having a great night, the music was good and the pub was busy.
Later in the evening Zac started talking to a friendly young woman. Shortly after Zac was approached by a man who aggressively accused Zac of talking to his girlfriend. Zac apologised and returned to his group of friends. Approximately an hour later Zac said goodbye to his friends as he decided to head home.
As Zac was leaving the pub he was followed out by the man who had earlier confronted him. The man was still verbally aggressive and ended up pushing Zac to the ground, resulting in Zac hitting his head on the cement curb of the road. The security guard saw this incident and intervened. Whilst Zac was not punched, he did sustain a laceration to the back of his head. The security guard noticed quite a bit of bleeding and rang an ambulance.
collect cues: paramedics: When the ambulance arrived, Zac had a GCS of 15 and could recall the whole incident. Zac appeared to have no other injuries. The paramedics undertook vital signs which they stated were ‘normal’ and applied a bandage to Zac’s head wound. The security guard stated that he ‘didn’t think Zac lost consciousness’.
triage:
- 18 year old male, brought in by ambulance following an alleged altercation where patient struck head on road curb at 2300 hrs.
- Patient is denies loss of consciousness but unable to recall all events. Patient appears alert but teary and takes a couple of moments to answer questions.
- On examination, 4cm occipital laceration noted with slow ooze from wound. Dressing insitu. Vital signs and GCS recorded at 2325 hrs as per chart. No other obvious injuries.
- Patient denies drug use, states has had approximately ‘five beers since 7pm’. Breath alcohol taken at 2330 hours 0.06%.
- Patient reports pain to be 5/10 at occipital region, no analgesia taken prior to presentation.
- Patient states is usually fit and well.
past medical history: Childhood asthma, up-to-date with immunisations (last tetanus 12 months ago).Not on any medications and no known allergies.
QUESTION:
A very important intervention for any deteriorating patient is to increase the frequency of observations undertaken. If Zac were to significantly deteriorate, what trend in his respiratory function might be observed? Explain the pathophysiological mechanisms which would cause these changes in details.
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