Return to Scenario ListShow Learning Points most relevant to Phase 1:

Altered level of consciousness in an adult

Clinical Discipline(s)/Organ System(s)
Emergency Medicine, Nervous System, Neurology, Intensive Care Medicine, Neurosurgery, Anaesthesiology
Progress Test Topic(s)
Seriously ill patient
A 28-year-old Māori man presents following a motor vehicle crash in which he was an unrestrained driver. Following a lucid interval, he is unresponsive on arrival to the Emergency Department. He has a dilated right pupil and his best motor response is abnormal flexion to painful stimulus. His blood pressure starts to rise and heart rate begins to fall.
Progress Test-Type Questions:   Question 1 | Question 2 | Question 3
Applied Science for Medicine 
   - Anatomy of the cranium and meninges
   - Physiology of intracranial pressure control
   - Aetiology of intracerebral bleeds
   - Pathophysiology of Cushing's response
   - Changes in the respiratory tract including airway, cardiovascular and nervous systems in the unconscious patient
Clinical and Communication Skills 
   - History from a major trauma patient, including collateral history
   - Perform focused neurological examination including calculating Glasgow Coma Score (GCS)
   - Role of the trauma team and multidisciplinary approach to the trauma patient
   - Perform a primary survey and the necessary practical skills: airway opening manoeuvres; cervical collar placement; obtaining vascular access, haemostasis and suturing
   - Perform a secondary survey according to trauma assessment protocols
   - Indications for trauma CT chest/abdomen/pelvis scans, CT head and neck and arterial contrast studies
   - Differential diagnosis of altered level of consciousness
   - Initial steps of managing an unconscious patient
Personal and Professional Skills 
   - Empathise with family/whānau member of a major trauma patient
   - Decision-making for others
   - Impact on whānau of long-term social care
   - Death certification and the role of the coroner
Hauora Māori 
   - Communication with whānau when a patient has a poor prognosis
   - Māori views on organ donation, autopsy and release of body and body parts
Population Health 
   - Sequelae of severe head injury: physical, cognitive and psychiatric complications; rehabilitation
   - Social impact of trauma, particularly in younger patients
   - Strategies for prevention of head injuries
Conditions to be considered relating to this scenario
head injury syndrome, haemorrhage (subdural, extradural, subarachnoid, intracerebral, intraventricular), cerebral oedema
Less common but 'important not to miss'
acute hydrocephalus, cerebral herniation syndromes, status epilepticus, spinal cord syndromes (central, anterior, Brown-Sequard)