like the thread started by betts this will be an exercise in critical thinking and clinical assessment/decision making. what i will do here is relate day by day a patient story. each time i post i will disclose more information just as would occur in real life. your responses will not affect the story. what will make this challenging for all is that the setting is rural/remaote area nursing.
place: small country hospital 3 hours drive from nearest "base" hospital. you do not have access to ct only x-ray machine -operated by rn's with "x-ray certification". no full time medical officer - local general practitioner "covers" the hospital for after hours on-call emergencies.
the story:- john p is escorted by police to your hospital at 2315. the background stroy you get from the police is that he has been in a drunken argument after consuming a "large amount" of beer at the local pub. john p has a large profusely bleeding scalp wound. he has slurred speech - reeks of alcohol and has a glasgow coma score (gcs)of 11/14. eye opening - 3/4 will only open eyes when you call him. verbal response 4/5 - confused, mostly slurrd swearing and abuse. motor response 4/5 not obeying but he is scored at this because every time you ask him to "squeeze your hand" he becomes abusive and tells you where to go. the medical officer is notified. he does not come in to see the patient. the wound is cleaned and sutured by the nursing staff and the patient is admitted "for observation" overnight.
