Enzo Bihari is a 19âyoâfull time university

Enzo Bihari is a 19âyoâfull time university nursing student. He keeps fit by riding mountain bikes, running and plays with theâuniâhockey team. He lives in a share houseâwhile on campus and goes home for holidays. He also works part-time as a bartender.â He went to the beach with some friends on a hot Saturday and hit his head on a sand bank when diving into the water. His friends saw him dive in and realised very quickly that although he was floating face down in the water, he wasn’t fooling around and actually was unable to turn over. His friends and lifeguards turned him, supporting his neck, and kept him warm until the paramedics arrived. Vital signs:â RR: 32 bpm (shallow) SpO2: 89%âon O2 15L/min via non re-breather mask BP: 94/55âmmHgââ (MAP 68 mmHg) HR: 64 bpm T: 37.9oC (tympanic)â Neurological assessment: GCS: eyes – 4; Verbal – 5; Motor – 6 Pupils: pupils equal (4 mm), round, and reactive to light and accommodation (PERRLA) Limb movements: as above in “Disability” notes Computerised Tomography report Exam Information Modality: CT Body Part: NEURO Description: CT Brain and C-Spine Performed Date: 25/3/Year Time: 1330 Final Report CT BRAIN AND C-SPINE CLINICAL NOTES: Witnessed dive into shallow water at beach. Immediately unable to reposition himself from being face-down in the water. Findings: A non- contrast CT has been acquired. C6 lesion with no vascular haemorrhages noted but some bloodâevident at C5 – 6 with bone fragments in the spinal canal.â Mild frontal lobe contusionâ IMPRESSION: Unstable C6 compression fracture X-ray Chest – decreased lung expansion upon inhalation; mild pulmonary oedemaâ Arterial blood gases pHâ-â7.27 (ref range: 7.35 – 7.45) PaO2â-â60 mmHg (ref range:â75 – 100 mmHg) PaCO2â-â52 mmHgâ(ref range: 35â- 45âmmHg) HCO3- -â25.2 mmol/L (ref range:â22 – 26 mmol/L) SaO2â-â88% Take Action “1/24 (hourly) neurological assessment for 12 hours” has been requested for Enzo, despite his GCS and pupillary response data being satisfactory. Provide a rationale for this intervention by: considering Enzo’s accident at the beach and CT findings, and identifying a risk problem other than his spinal cord injury referring to relevant anatomical structures and discussing the pathophysiological mechanisms that may cause changes to Enzo’s neurological assessment; Glasgow Coma Scale, Pupils, and identifying guidelines or clinical pathways that support this intervention.

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