Abstract
The patient is a 20-year-old male who was a pedestrian struck by a moving motor vehicle at a speed of 40 to 50 miles per hour. He was brought in to the emergency department (ED) with a Glasgow Coma Scale score of 5 (V1, E2, M2). He was intubated in the ED. His vital signs were as follows: heart rate of 126 beats per minute, blood pressure of 130/78, spontaneous breathing but on the ventilator, and neurological examination consisting of flexor posturing in the upper extremities and slight withdrawal in the lower extremities. His pupils were 4 mm and reactive, there was no blink to threat, and he did not open his eyes to voice or deep stimuli. His initial CT head scan demonstrated a small left subdural hematoma, blood in the left lateral ventricle, a left orbital fracture, and a right occipital fracture. Subsequent imaging also showed pneumocephalus in the anterior horns of the lateral ventricles and small blood in the posterior pons.
This hospital has a designated specialized neuro-ICU, with 24/7 coverage, residents, and NPs. However, there were no beds available at this time. The patient was admitted to a medical-surgical ICU.
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