Further to this morning’s teaching anecdote, my friend Reuben has recently been given the task of shepherding a group of impressionable med students through their Introduction to Emergency Medicine. Below is an excerpt from the final exam he presented them with this morning:
You are walking home after a busy day as a medical student, you are feeling overwhelmed by work and wondering if it’s really worth it, training to be a physician in this day and age when medicine is plagued by falling salaries, frivolous lawsuits, and unprecedented bureaucratic headaches. You are thinking about your roommate, whom you don’t find particularly bright but has a job in finance that pays her half-million dollar bonuses. As if on cue, she appears on the corner of the street and you two start walking together. Suddenly a man falls off a scaffolding and lands directly in front of the two of you with a thump. You both look at him, he is unconscious and a pool of blood is developing around his head.
1. What are the initial priorities?
2. After addressing these initial issues, you approach the patient. He is unconscious. Outline your approach.
3. Describe the most important components of a focussed neurological exam in this patient.
Your roommate, who just got a .6 million dollar bonus, gives you five thousand dollars because she feels bad, you working long hours for nothing and all. You decide you need a new preamplifier, so you go to your local ritzy stereo place and there it is: the Marantz AV8003 Networking Preamp/Processor. You note that it supports Digital Media Player for Ethernet – Audio, Video and Photo (supporting DLNA) as well as video scaling and processing by Anchor Bay Technology, that it sports Precision Video Scaler which allows up to 1080p scaling and full 10bit video processing. You’re amazed that it features HDMI V1.3a: 4-in/2-out, Dolby TrueHD, dts HD, Deep Color, DSD (SA-CD), Auto Lip Sync, XLR Pre Output Terminals for 7.1ch, XLR Audio Inputs for CD/SA-CD, Multi Zone Component Video Out, RC2001 Main Zone Remote (PC Programmable, Learning), RC101 Sub Zone Remote, HD Radio / XM Ready / Sirius Ready capability, THX ULTRA2 Certification, Copper Plated Chassis, and Toroidal Power Transformer. The salesman, a handsome gentleman in his late 50s, notices how interested you are in the unit, clutches his chest and drops to the ground.
1. What is your initial response to this turn of events?
2. What is in your differential for possible etiologies of this patient’s symptoms?
3. What risk factors predispose to the most likely diagnosis?