Clinical Reasoning Report: Analysis of a Concussion Case Study

This clinical reasoning report presents an analysis of a concussion case involving Mr. John, who sustained a head injury in a motorbike accident. The report details the patient's situation, subjective and objective data, including symptoms like headache and elevated blood pressure. It explores the pathophysiology of concussion, assessment tools, and the importance of protective gear. The report provides a comprehensive overview of the patient's condition, assessment data, and recommendations for management, including the importance of wearing helmets. The report also includes a discussion of the patient's objective data, such as pulse rate, respiratory rate, and blood pressure, and how they relate to the concussion. The conclusion emphasizes the significance of early intervention and appropriate assessment for traumatic brain injuries. It also includes references to support the analysis.

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CLINICAL REASONING REPORT
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Contents
Executive summary...............................................................................................................3
Introduction...........................................................................................................................4
Body......................................................................................................................................4
Patient’s situation..................................................................................................................4
Cues and information............................................................................................................5
Recommendations.................................................................................................................8
Conclusion.............................................................................................................................9
References...........................................................................................................................10

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Executive summary
Mavis called her son Sam to inform him about his father's condition. Mavis scrutinized
that her hubby John appeared to be somehow inactive and quiet. Furthermore, John had not
eaten his dinner that night. John's father was returning home for breakfast from the dairy
when he was involved in an accident. He lost balance on his motorbike, fell off on the ground
and hit his head on the ground. He hardly wore his helmet and on this fateful day, he
sustained injuries on his left elbow and his right left forearm. Mavis, therefore, rang his son
so that John could be taken to the emergency department. Despite the accident, John insisted
that he felt no pain, reduced limbs or neck movement and stiffness. Mr. John, however,
complained that he was feeling obscured with a 4/10 headache. Apparently, after hitting his
head he felt dizzy but never lost consciousness. Mr. John's assessment data or cues have to be
collected using well detailed and organized assessment criteria which can link the incident to
the structural and functional occurrences within the victim's body.

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Introduction
A concussion refers to traumatic injury of the brain due to a blow, bump or jolt to the head
(McCrory et al 2017). The brain can, therefore, twist or bounce within the skull as a result of
the sudden movement leading to change in the chemical composition of the brain and
damaging and stretching of the brain.
Headache is the most common symptom of a concussion. Other signs include the
following: depression, nausea, light and noise sensitivity, drowsiness or fatigue, sleep
patterns alteration and sadness (Thomas et al 2015). If left untreated, concussions may have
serious long term effects. Some of them are loss of memory, lack of concentration, taste and
smell disorders and other psychological related implications.
Continuous blows to the head or previous concussion are the biggest risk factors for
concussion. Mr. John, for instance, became a victim after losing balance on his motorbike and
directly hitting his head on the ground.
Appropriate assessment tools such as gait and balance testing, cognitive and symptom
scales can be put in use for evaluation (Nelson et al 2016).
Body
Patient’s situation
The victim is suffering from concussion with the headache, dizziness, and lack of balance.
Falls have been classified as the number one cause of traumatic brain injuries among the
elderly. John's condition has been contributed by a fall. Participation in high-risk sports such
as boxing, rugby, and hockey is also likely to cause a concussion.

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Cues and information
In this scenario, subjective data comprises of the information provided by Mr. John, his
wife or son. Subjective data is best obtained through interviewing a patient (Morales et al
2017). Some of the subjective data provided by the patient here include headache, losing
balance and dizziness.
On the other hand, objective data refers to quantifiable and observable symptoms arrived
on upon physical examination, diagnostic or laboratory testing, and observation (Rhee et al
2016). The following objective data were recorded upon arrival at the hospital:
Pulse rate: 81 bpm
Respiratory rate: 17bpm
Temperature: 36.7 degrees Celsius
SpO2: 97%
Blood pressure: 148/84 mmHg
Normally, the pulse rate of a stable human ranges from 50- 100 beats per minute, a pulse
rate of 60- 82 is most prevalent in the concussion heart (Sikdar, Behera and Dogra 2016).
This is an indication that the interprocess communication to John's heart from his brain is
subjected to tension during a concussion. Cardiac output (amount of blood that the heart
pumps) is stabilized by tighter control of the human heart.

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Ideal blood pressure should be 120/90 mmHg (Ettehad et al 2016). 140 over 90 or higher
readings is an indication that one is suffering from high blood pressure or hypertension.
John's high blood pressure diagnosed at the hospital resulted from the tension created when
his heart is pumping blood. From the above discussion, it is clear that blood pressure and
pulse rate are the patient’s objective data that were found to be abnormal.
Scientifically, an ideal body temperature of a human being should read 37 degrees Celsius
(Liu et al 2016). The patient recorded a body temperature of 36.7 degrees Celsius which is
very close to 37 degrees Celsius, therefore, lies within the normal range. Peripheral capillary
oxygen saturation (SpO2) refers to an estimated amount of oxygen found in the blood (Lynn
and Lynn 2015). It can also be defined as the ratio of non- oxygenated blood to oxygenated
blood. The normal saturation of oxygen level should be 97- 100%. John was, therefore,
having a normal SoP2. His rate of respiration was also among the normal objective data.
It's important to come up with assessment data to be collected from Mr. John concerning
information he gave out when he was interviewed and the post-examination results from the
concussion emergency department at the hospital. The following assessment data ought to be
collected: Balance examination, state of the patient's mental ability, pulse rate, blood
pressure, and respiratory rate.

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Assessments that can be carried out on Mr John at the emergency department
A psychological status assessment- ought to incorporate attention assessment, memory,
and review. Orientation is ordinary aside from in the most acute assessments.
Cranial nerve assessment- must incorporate cautious evaluation of eye-movement control,
including saccades and smooth pursuit. Be that as it may, even in patients with prominent
subjective dizziness, impressive experience might be expected to really show variations from
the norm.
Testing of balance- balance needs cautious evaluation. This testing ought to be more
troublesome than the eyes-shut and tandem gait, feet-together tests.
Sensory, reflex, standard strength and coordination testing is typically ordinary.
Any focal neurologic discoveries should incite thought of different causes or of
progressively genuine damage and should prompt further assessment, including imaging of
the brain.

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Information processing and relation
The patient was lucky to have not suffered from some of the most common signs and
symptoms of concussion such as loss of memory, lack of concentration, taste and smell
disorders, light and noise sensitivity, fatigue among others. However, from the discussion, it
is clear that John's headache and increased blood pressure came about as a result of
concussion. Headaches are a common phenomenon but they usually fade away after some
weeks or days. In the case of migraine as a result of a concussion, one is advised to place a
hot or cold pack around the head or neck, engage in relaxing exercises or taking a deep
breath. Hypertension is lethal since it overworks the heart to supply the body with blood
(Laurence et al 2019). Following John’s incident, he is likely to have hurt his thalamic area
and the upper medulla oblongata. In this scenario, high blood pressure might not only have
been caused by overworking of the heart but also as a result of a neuroendocrine tumour of
the medulla of the adrenal glands.
Recommendations
It is highly recommended that whenever one is riding a motorbike he or she should wear
protective gear to ensure safety. Helmets, for instance, protect the head from directly getting

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hit therefore reducing chances of concussion occurrence. If Mr. John had put on his helmed
maybe he might not have ended up in the hospital.
Conclusion
Traumatic injury of the brain if not treated early enough can be lethal. John’s family acted
swiftly by taking him to the health facility as soon as he reported the incident. This was of
great help to him as he was subjected to advanced assessment for proper treatment.

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References
Ettehad, D., Emdin, C.A., Kiran, A., Anderson, S.G., Callender, T., Emberson, J., Chalmers,
J., Rodgers, A. and Rahimi, K., 2016. Blood pressure lowering for prevention of
cardiovascular disease and death: a systematic review and meta-analysis. The
Lancet, 387(10022), pp.957-967.
Laurence, D., Ross, C., Jett, S., Johns, C., Echols, A., Baumwart, R., Towner, R., Liao, J.,
Bajona, P., Wu, Y. and Lee, C.H., 2019. An investigation of regional variations in the biaxial
mechanical properties and stress relaxation behaviors of porcine atrioventricular heart valve
leaflets. Journal of biomechanics, 83, pp.16-27.
Liu, L., Shen, B., Jiang, D., Guo, R., Kong, L. and Yan, X., 2016. Watchband‐Like
Supercapacitors with Body Temperature Inducible Shape Memory Ability. Advanced Energy
Materials, 6(16), p.1600763.
Lynn, L.A. and Lynn, E.N., 2015. System and method for automatic detection of a plurality
of SPO2 time series pattern types. U.S. Patent 9,042,952.
McCrory, P., Meeuwisse, W., Dvorak, J., Aubry, M., Bailes, J., Broglio, S., Cantu, R.C.,
Cassidy, D., Echemendia, R.J., Castellani, R.J. and Davis, G.A., 2017. Consensus statement
on concussion in sport—the 5th international conference on concussion in sport held in
Berlin, October 2016. Br J Sports Med, 51(11), pp.838-847.
Morales, J.M., Diaz-Piedra, C., Rieiro, H., Roca-González, J., Romero, S., Catena, A.,
Fuentes, L.J. and Di Stasi, L.L., 2017. Monitoring driver fatigue using a single-channel
electroencephalographic device: A validation study by gaze-based, driving performance, and
subjective data. Accident Analysis & Prevention, 109, pp.62-69.

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Nelson, L.D., LaRoche, A.A., Pfaller, A.Y., Lerner, E.B., Hammeke, T.A., Randolph, C.,
Barr, W.B., Guskiewicz, K. and McCrea, M.A., 2016. Prospective, head-to-head study of
three computerized neurocognitive assessment tools (CNTs): reliability and validity for the
assessment of sport-related concussion. Journal of the International Neuropsychological
Society, 22(1), pp.24-37.
Rhee, C., Kadri, S., Huang, S.S., Murphy, M.V., Li, L., Platt, R. and Klompas, M., 2016.
Objective sepsis surveillance using electronic clinical data. infection control & hospital
epidemiology, 37(2), pp.163-171.
Sikdar, A., Behera, S.K. and Dogra, D.P., 2016. Computer-vision-guided human pulse rate
estimation: a review. IEEE reviews in biomedical engineering, 9, pp.91-105.
Thomas, D.G., Apps, J.N., Hoffmann, R.G., McCrea, M. and Hammeke, T., 2015. Benefits of
strict rest after acute concussion: a randomized controlled trial. Pediatrics, 135(2), pp.213-
223.