Critical Thinking Questions and Case Study 44-year-old construction worker fell

Question

Critical Thinking Questions and Case Study

44-year-old construction worker fell from the building while work on. At arrival, EMT personnel found him unconscious, but in stable vital signs. He was placed on backboard (to stabilize his head, neck, and back) and the EMT crew noticed watery blood leak from his R ear. Arriving at the hospital, patient regained his consciousness and was treated for deep lacerations on his scalp and face. Head CT indicates both longitudinal and transverse fractures on his R petrous temporal and sphenoid bones that extended through the foramen rotundum and foramen ovale. Here is what record on patient’s chart was:

·        Complete loss of hearing in the R ear

·        Paresthesia at the R corner of the mouth, extending to the lower lip and chin

·        Numbness of the R upper lip, lower eyelid and cheek

·        R eye turn slightly upward when looking straight ahead. Diplopia (double vision) when looking to the right.

Questions:

1.   What is the best description for fluid leak from his ear and what cause that leak?

2.   Damage of the cranial nerve was observed – identified each cranial nerve involved. If applicable, identify which specific branch of that nerve is involved

3.   Why doctor would give him antibiotics based on the observations presented in his chart? Why also the head was elevated while in bed?

4.   24 hours later, it has been found that yet another cranial nerve was damage. Provide the best explanation for this new observation including the lack of tear production.

Explanation / Answer

1.Because the temporal bone damage occurs which provides part of the inferior wall of cranial cavity,trauma may result in the leakage of CSF into the middle ear cavity,if the tympanic membrane is also damaged which results in the drainage of CSF through the external acoustic meatus

2.Due to temporal trauma can result in the injuries of vestibulocochlear nerve (CN VIII) and facial nerve(VII) ,temporal branches of facial nerve are damaged

3.Because of the precaution to take for the leakage of CSF because of intracranial haemorrhage.The head should not be tilted and should kept in steady and elevated position because trauma results in damage to brain and meninges which causes meningitis and cerebral contusion

4.Trigeminal nerve distribute sensory supply and parasympathetic supply from facial nerve which involves in tear production due to trauma these cranial nerves are damaged

Temporal trauma complications are hearing loss,facial nerve paralysis and CSF fistula

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