•A 29 year old female is brought into emergency departement by ambulance. She
and her horse tumbled after failing to clean an obstacle on the obstacle
course.
•She fell sideways and feel head first onto the ground
and her horse fell sideway ontop of her; she was wearing a helmet at that time.
•Immedietly after falling she was able to speak to onlookers and altough she was dazed, her
eyes were open, she knew where she was and she complained of pain over the back
of her head, abdomen, and hip.
•She could not move her legs due to pain at her hips.
•Paramedics report that her concious level decreased on
the way into hospital. On assessment at the time of arrival in emergency departement by doctor, she is
unable to follow commands; her eyes are closed and only open when paintful stimuli are
administered above her eyes or over her sternum or when palpitation of her
abdomen and pelvis made.
•She makes mumbing noises which make no sense. Her arms and legs withdraw
away from painfull stimuli. The patient
appeared anaemic.
•Initial assessment begins with evaluation of airway,
breathing and circulation.
•Her respi rate :18x/minute.
•Her O2 saturation are 100% on 4 L O2.
•HR 112x/minute
•Blood preasure systolic 80mmHg. No diastolic found.
•On examination, there no palpable fracture over her
skull altough tere is large hematoma
above her right ear. There is large bruise on her lower abdomen and hip.
•Her pupil are equal and reactive to light. Both side her
face grimace when oreassure is placed at supraorbital regions. Altough she is unable to
respond commands, her upper limb and feet flex in responses pain stimuli. Her
tone appears normal altough reflexes are briseker on the right and her
right plantar is up going.
•Her whole abdomen was tender and rigid, especialy below umbilicus.
Bowel sound were Normal. The patient cried out loud when preasure was applied on her
pelvis.
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