Ep 4: A 45-year-old who lost consciousness following a road traffic accident

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Every case has a script. Clinical approach is a collection of hypothetical case discussions with questions that test the key concepts for a particular disease presentation.

A 45-year-old male motorcyclist is brought to the Emergency Department after hitting the rear-end of a car at highway speeds. He was wearing a helmet but was thrown from his motorcycle. He was found awake in the field by paramedics, but then quickly became unconscious. His airway is patent, but his respiration is shallow and irregular. His blood pressure is 150/90 mmHg, heart rate is 60 beats per minute, and respiratory rate is 20 breaths per minute. In response to the sternal rub, he moans and withdraws his right upper and lower extremities. He does not move his left upper or lower extremity, and he does not open his eyes. His right pupil is 6mm and non-reactive, while his left is 3mm and reactive to light. There is no obvious head injury or laceration. There is no discharge from the nose or the ears. However, there is a right hemotympanum. The oropharynx is clear. The rest of the physical exam is normal.