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BIOS 252 Week 5 Case Study

Introduction

The human body is a complex structure, and it is susceptible to injury from various sources. In the case of the patient being discussed, they have suffered multiple injuries from the blast caused by an explosion. The injuries suffered have the potential to be severe, and it is essential to assess them thoroughly.

One of the most significant injuries the patient has suffered is the fracture of the cribriform plate located in the ethmoid bone. The cribriform plate is a thin section that forms the roof of the nasal cavity and is highly vulnerable to fractures caused by blunt force trauma or a primary blast from an explosion. Such injuries pose a significant risk of cerebral spinal fluid (CSF) leakage, which can lead to various complications, including infection, meningitis, or pneumocephalus (Gomez & Pickup, 2022).

BIOS 252 Week 5 Case Study

To determine the extent of the patient’s injury, a CT scan is performed. However, a CT scan may not be enough to determine if there is CSF leakage. As a result, a non-invasive procedure called a Pledget study is conducted. The Pledget study involves inserting cotton pads known as pledgets into the nose. A positive result in the pledget study would be indicated by the presence of a ring of clear to yellowish fluid surrounding the blood-soaked pledget. However, while this study can confirm the existence of CSF leakage, it does not provide information about the location of the leakage.

The patient also presents with distortions in their vision. This symptom could be attributed to ruptured blood vessels within the vitreous body, a jelly-like substance that fills the inside of the eye. The vitreous body serves the purpose of maintaining intraocular pressure and allows the extrinsic muscles to move the eye without causing distortion (Saladin, 2020). This structure is heavily supplied with blood vessels, which play a crucial role in focusing images on the retina (Saladin, 2020). Damage to the vitreous body can significantly impact visual capabilities. To rule out the possibility of vitreous hemorrhage, a diagnostic procedure known as fluorescein angiography is performed. This non-invasive test involves injecting a dye into a vein, which then travels to the blood vessels of the eye. Any leakage of the dye from damaged blood vessels can be observed during the procedure, thereby confirming the presence of vitreous hemorrhage.

BIOS 252 Week 5 Case Study

The patient also suffers from bilateral tympanic membrane perforation. The tympanic membrane is a thin membrane that separates the outer ear from the middle ear and has certain limits to its ability to withstand pressure differentials. It may rupture when the pressure exceeds 35 Psi (Baum et al., 2010). Considering the patient’s close proximity to the explosion, it is reasonable to assume that the blast waves generated had pressures above 35 Psi, leading to the bilateral tympanic membrane perforation. Furthermore, if the blast waves exerted a pressure exceeding 40 Psi, it could have also affected hollow organs such as the lungs due to the fragmenting and shearing of tissues caused by the intense pressure (Jorolemo et al., 2022).

Conclusion

In conclusion, the injuries suffered by the patient in the explosion are severe and require immediate medical attention. The cribriform plate fracture presents the most significant risk of complications due to CSF leakage, and the Pledget study and CT scan provide essential information for the diagnosis and treatment of this injury. The distortions in vision could be attributed to vitreous hemorrhage, which is confirmed or ruled out through fluorescein angiography. The bilateral tympanic membrane perforation is yet another injury that requires immediate attention. The medical team must work together to develop a comprehensive treatment plan to address each of the injuries suffered by the patient.

Reference

Baum, J. D., Rattigan, M. I., Sills, E. S., & Walsh, A. P. (2010). Clinical presentation and conservative management of tympanic membrane perforation during intrapartum.

https://doi.org/10.1155/2010/856045

Gomez, J., & Pickup, S. (2022). Cribriform Plate Fractures.

https://www.ncbi.nlm.nih.gov/books/NBK562192/

Jorolemon, M.R., Lopez, R.A., & Krywko, D.M. (2022). Blast Injuries.

https://www.ncbi.nlm.nih.gov/books/NBK430914/

Saladin, K. S. (2020). Anatomy & Physiology: The Unity of Form and Function (9th ed.). McGraw-Hill Higher Education (US).

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