Damien Brooks traumatic brain injury shadow health Transcript
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Hello, I am xxx. I will be interviewing you today and later perform a physical examination
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Greet |
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Hey.
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What is your name?
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Damien Brooks and my birthday is July 25th, if you want to get me anything. [AUDIO COMING SOON] Damien Brooks traumatic brain injury shadow health
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Okay
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Empathize |
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Thanks, Nurse.
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What brought you into the hospital?
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I banged my head up pretty bad and got this big bump. Tim took me to the ER after I threw up. I know puking is a bad sign. Can confirm it’s also a bad time.
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Sorry about the bump and the pain
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Thanks.
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How did you sustain the bump? (No matching questions found.) Damien Brooks traumatic brain injury shadow health
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What happened?
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I’m not really sure, to be honest.
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I understand
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Cool, I appreciate that.
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Di you fall? (Clarified to Did you fall?.)
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Yeah, I took a dive. I don’t remember it really at all though, but I can tell I hit my head. No idea how it happened, usually I shred. (Clarified to if I fell.)
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Do you have a headache?
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Yeah, I definitely have a headache. It hurts to look at light, even. [AUDIO COMING SOON]
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| Damien Brooks traumatic brain injury shadow health | ||
ORDER A PLAGIARISM-FREE PAPER OR SHADOW HEALTH HELP HERE |
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| Damien Brooks traumatic brain injury shadow health | ||
| Damien Brooks traumatic brain injury shadow health | ||
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Do you normally wear sport safety gear? (Clarified to Do you usually wear a helmet?.)
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Not usually, but we’ll practice with them on sometimes. (Clarified to if I usually wear a helmet.)
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why do you not wear helmet?
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No one does, really. It looks goofy. Especially on film. I dunno . . . I just kind of got out of the habit.
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It is always safe to wear sports safety gear such as helmet
Damien Brooks traumatic brain injury shadow health
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Educate |
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Ok, I’ll keep it in mind.
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Do you take alcohol?
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No, officer.
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Do you take illegal drugs?
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Nah. Not into it.
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Do you smoke tobacco?
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That doesn’t really fit with my brand.
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That is good. Smoking, alcohol and drugs are bad for your health
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Educate |
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Sure, yeah.
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Do you have changes in vision? (Clarified to Has your vision changed since the accident?.)
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I can see just fine, my eyes just feel a little light sensitive. (Clarified to if my vision has changed since the accident.) Damien Brooks traumatic brain injury shadow health
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Do you have difficulties moving your extremities? (Clarified to Are you having any issues moving your legs?.)
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I’m not feeling awesome right now, but I can move around okay. (Clarified to if I have difficulty moving my legs.)
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Do you have any tingling?
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No, no tingling or anything.
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Do you have ear problem? (Clarified to Do you have ringing in your ears?.)
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No, I don’t have any ringing in my ears. [AUDIO COMING SOON] (Clarified to if I have ringing in my ears.)
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Do you have memory problems?
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Yeah, the whole wipe out is a blur. Kinda messed up not being able to remember stuff.
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Do you have neck pain?
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My neck is fine.
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do you have muscle weakness? Damien Brooks traumatic brain injury shadow health
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I’d say I’m pretty strong.
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Do you have muscle spasms?
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Haven’t had any muscle spasms.
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Do you have gait or balance problem?
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I can walk pretty OK, it’s my head that’s bothering me.
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What is your relationship with the patient?
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I’m his stepfather.
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What happened to your step-son? (Clarified to Talk to me about what had happened to your son?.)
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He was at the skatepark after school, like he usually is, and he fell off his board while doing a grind. He didn’t have a helmet on, which we’re going to have to chat about later . . . (Clarified to to tell you what happened to my son.)
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Yeah, it is good to have a helmet
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Thanks, yeah, I’ll remember that.
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Did you notice any headache for your son? (No matching questions found.)
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Does he have a headache?
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Yes, Damien’s had a headache since he got home.
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Does he have dizziness? (No matching questions found.)
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Did he have dizziness?
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I didn’t give him anything at home, but they gave him some medication when we got here — acetaminophen, I think.
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Did he have confusion? (No matching questions found.)
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Did your son have scalp hematoma? (No matching questions found.)
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Did he have scalp hematoma? (No matching questions found.)
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Did you notice any blood
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I didn’t notice any bleeding. [AUDIO COMING SOON]
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Is your son son complaining of light sensitivity? (No matching questions found.)
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Is your son complaining of light sensitivity? (Clarified to Has your son been sensitive to light?.)
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Yes, definitely. (Clarified to if my son has been sensitive to light.)
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Did he report vomiting? (No matching questions found.)
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Did he have any vomiting? (Clarified to Has your son vomited?.) Damien Brooks traumatic brain injury shadow health
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It was after Damien came home and told me he had fallen. He was feeling dizzy and had a headache. He threw up pretty soon after that, and that’s when I decided to drive him over here. (Clarified to if my son has vomited.)
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Did you notice any other additional symptoms? (Clarified to Have you noticed any other injuries on your son?.)
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I haven’t noticed any other injuries on Damien other than the welt on his head. (Clarified to if I have noticed any other injuries on my son.)
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Describe the onset of the symptoms? (No matching questions found.)
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Describe the onset of the head injury (No matching questions found.)
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what is the duration of the pain? (No matching questions found.)
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How frequent is the headache? (No matching questions found.)
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Describe the frequency of the pain (No matching questions found.)
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did you notice confusion? (Clarified to When did you notice your son’s symptoms?.)
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He’s been dizzy and confused at least since he got home. Kyle said he was complaining about both on the walk back from the skatepark. (Clarified to when I noticed my sons symptoms.)
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Did you notice dizziness? (Clarified to Did you see blood?.)
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I didn’t notice any bleeding. [AUDIO COMING SOON] (Clarified to if I saw blood.)
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When did the fall occur?
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Damien fell about two hours ago.
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Describe the mechanism of the injury? (No matching questions found.)
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how did your son fall?
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He was balancing on a rail and just lost his balance. His friend Kyle was recording it, so I watched the video. A hard thing to see.
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did he lose consciousness?
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Yeah, the fall knocked Damien unconscious.
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What are relieving factors for the pain?
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I gave him an ice pack and laid him down on the couch. I tried dimming the lights too. But once he threw up, I decided I was out of my depth and drove him here.
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What makes the pain worse? Damien Brooks traumatic brain injury shadow health
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I’m not sure what all can make his pain worse right now. I know he’s said that light hurts his eyes. [AUDIO COMING SOON]
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Okay. i understand
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Empathize |
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Well, that’s kind of you to say.
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Has your son received all vaccinations? (No matching questions found.)
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Has he had all vaccinations? (Clarified to Does your son have all his vaccines?.)
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Yes, he’s got all his shots. (Clarified to if my son is vaccinated.)
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That is great. Vaccinations are very important for good health
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I gotcha, loud and clear. Damien Brooks traumatic brain injury shadow health
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Has he ever been hospitalized?
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Damien’s never been to the hospital before. We’re very lucky, especially if he hasn’t been wearing his helmet like this time. He’s definitely fallen in the past.
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Has he ever had head injury? (Clarified to What previous head injuries has your son had?.)
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Damien doesn’t have any previous head injuries. (Clarified to what my sons past head injuries are.)
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Has your son had any surgery?
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Damien’s never had surgery.
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What home medication does your son use? (No matching questions found.)
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Any home medications? (No matching questions found.)
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what medications is your son using?
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Really just acetaminophen when he has a fever and the like. He almost never takes any medication at all.
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Is your son having dizziness? (No matching questions found.)
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Any eye problem for your son? (No matching questions found.) Damien Brooks traumatic brain injury shadow health
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Any eye problem? (No matching questions found.)
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Does your son have eye problem? (No matching questions found.)
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Does your son have headache?
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Yes, Damien’s had a headache since he got home.
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Does he have vision issues?
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Damien’s only mentioned the light sensitivity. [AUDIO COMING SOON]
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Any ear problem? (No matching questions found.)
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Does Damien have ear issues? (No matching questions found.)
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Any issues with the ears (No matching questions found.)
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Has your son’s speech changed? (No matching questions found.)
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Is he able to follow instructions?
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He’s been walking fine. [AUDIO COMING SOON]
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Does he have confusion? (No matching questions found.)
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Has your son had confusion?
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I didn’t give him anything at home, but they gave him some medication when we got here — acetaminophen, I think.
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Does your son have movement problem? (No matching questions found.)
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Does your son have issue with movement? (Clarified to Does your son have any balance or gait issues?.)
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Nope, he’s been getting around just fine. (Clarified to if my son has any balance or gait issues.)
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ORDER A PLAGIARISM-FREE PAPER OR SHADOW HEALTH HELP HERE |
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| Damien Brooks traumatic brain injury shadow health | ||
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Exam Action |
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Inspected head front: No abnormal findings
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Inspected left eye
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Inspected right eye
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Inspected left eye
Damien Brooks traumatic brain injury shadow health
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Inspected right eye
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Inspect e o m
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Inspect shoulders
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Inspected left shoulder
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Inspected upper back
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Inspected right shoulder
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Inspected shoulders from the front
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Inspected right shoulder
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Inspected upper back
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Inspected left shoulder
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Inspected shoulders from the front
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Inspect arms
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Inspect elbows
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Damien Brooks traumatic brain injury shadow health Inspected left wrist
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Inspected right wrist
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Inspected both hands
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Inspect hips
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Inspect thighs
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Inspect thighs
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Inspect knees
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Damien Brooks traumatic brain injury shadow health Inspect lower legs
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Inspect ankles
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Inspect feet
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Checked ID band
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Auscultated breath sounds
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Auscultated heart sounds
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Auscultated breath sounds
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Palp cardio pulses radial
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Confirmed orientation
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What is your name and date of birth?
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I’m Damien Brooks. It’s . . . [Mr. Brooks reports his correct date of birth.]
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What building are you now?
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We’re at Dr. Pulaski’s office, right?
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what is the date and year
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Today? It’s . . .[Mr. Brooks reports the correct date.]
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Do you know what’s going on?
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Wiped out on my board and knocked my head, which ended me up here. It’s pretty messed up.
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Assessed cognition
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repeat and remember burger, tulip, nose and tea
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Burger, tulip, nose, tea. Damien Brooks traumatic brain injury shadow health
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how did you celebrate your birthday?
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My birthday? Oh, this year it was actually pretty sick. The squad threw a surprise party for me. They like ambushed me the morning of, had a cake and candles and everything for me right there in bed. The day just went from there. It was a good start to 15, yeah.
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repeat the four words from before
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Burger . . . nose? Tea?
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Vocabulary
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Assessed speech
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Assessed speech
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close your eyes and touch your fingers to your nose
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I can do that.
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Observed left index finger to nose smooth and accurate Damien Brooks traumatic brain injury shadow health
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Observed right index finger to nose smooth and accurate
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run your right foot down your shin
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Sure.
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Observed right heel moving to shin smooth and accurate
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run your left foot down your right shin
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Ok.
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Observed left heel moving to shin smooth and accurate
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place your hands on your knees and turn them over
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Sounds good
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Observed rapid alternating hand movements
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Eye Opening Response measured as “spontaneously “
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Measured Damien’s best verbal response
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Measured Damien’s best motor response
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Determined Damien’s Glasgow Coma Score
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Tested ROM of elbows – supination and pronation
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Tested ROM of elbows – flexion and extension
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Tested ROM of wrists – flexion
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Tested ROM of wrists – extension
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Tested ROM of wrists – ulnar and radial deviation
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Tested ROM of hips – flexion
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Tested ROM of hips – extension
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Tested ROM of hips – abduction Damien Brooks traumatic brain injury shadow health
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Tested ROM of hips – adduction
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Tested ROM of knees – flexion
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Tested ROM of knees – extension
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Tested ROM of ankles – inversion and eversion
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Tested ROM of ankles – dorsiflexion and plantar flexion
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Tested right and left hand strength with grip test: 5/5
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Strength test feet
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Tested left arm distal sensation
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Tested left arm proximal sensation
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Yeah.
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Yeah.
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Tested right arm proximal sensation
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Yeah.
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Tested right arm distal sensation Damien Brooks traumatic brain injury shadow health
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Yeah.
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Yeah.
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Tested left leg distal sensation
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Yeah.
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Tested left leg proximal sensation
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Yeah.
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Tested right leg proximal sensation
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Yeah.
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Tested right leg distal sensation
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Yeah.
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Tested sensation of left foot
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Yeah.
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Tested sensation of right foot
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Palpated cap refill
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Reflex hammer patellar mode
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Reflex hammer brachioradialis mode
Damien Brooks traumatic brain injury shadow health
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