Case of the week 15/01/2014

A 50 year old business man was brought into the Emergency Department by ambulance.  A work colleague had accompanied him and had called the ambulance.  Apparently they had been celebrating a business deal by spending the afternoon in a pub.  The patient had gone outside for a smoke and when he had not returned 15 minutes later, the colleague found him outside at the back of the Pub, at the bottom of  4 steps.  The patient was incoherent and covered in vomit.  The Paramedics thought the patient was drunk and had managed to walk him into the ambulance and have him lie down.  Vital signs performed by the Paramedics were within the normal range but the patient just wanted to curl up and go to sleep.  On arrival to the Emergency Department, he was allocated a "Major's cubicle".  You examine the patient and find:

Airway - Open and Clear

Breathing - Spontaneously, 12 breaths/min, Chest Clear, Sat 96% on air,

Circulation - well perfused, Pulse 70/min, BP 140/100 mmHg

Disability - Eye open to Painful stimuli, Groans to Painful Stimuli, Feeble attempt to withdraw painful stimuli by both hands

Further findings on Examination:

Occipital Haematoma with Scalp Laceration - bleeding on to the trolley

No other evidence of Trauma.

Pupils equal and reactive to light

Ears - Normal

No needle marks

BM Stix 7 mmol/l


  1. What's the GCS
  2. What's your working diagnosis
  3. What's your management

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