Week 3

S: 83 year old male presented with acute dysarthria and right sided weakness following a fall one day ago. Patient (pt) is the primary carer for his wife who has dementia. Primarily Macedonian speaking and English as a second language. Previously independent with all duties and ambulating independently. Past medical history includes hypertension and carotid stenosis. Pt sustained left subdural haemorrhage and underwent a craniotomy and evacuation. T: Perform a full neuro assessment for the patient including tone, passive range, GCS, mobility and cranial nerves. A: I measured the pt’s range of motion, established an appropriate form of communication, measured tone and performed a mobility assessment to handover to the nursing staff. R: I was able to carry out a thorough neuro assessment. The pts range was within normal limits, cranial nerves were intact, the pt required 2 people to assist with bed mobility and maintaining sitting balance so the patient was not for ambulation. The patient was also set up with a stock wheelchair to be hoisted out of bed into daily as the patient was not for transfers. E: The patient tolerated well although it was hard to communicate with the pt initially as only short clear commands were understood and I was unable to explain the reasoning or educate the patient on the role and purpose for physio. This also altered the pt's GCS level due to confusion as a result of the language barrier. S: I asked my supervisor for feedback after the assessment and I was able to attain better forms of communication particularly with a head injury and also a pt that does not primarily speak English. I then used these for further treatment sessions throughout the week with good effect.

Week One

S: 75 yr old male post intraventricular bleed found collapsed in home by wife ?fall ?collapse ?duration. Patient (Pt) was on warfarin increasing the bleed. Pt treated with extraventricular drain to remove bleed. Pt previously ambulant. Pt has history of asbestosis. Pt currently trache in situ and decuffing regime currently undertaken. Speaking valve in situ. Pt 2 person assist with slide sheet with bed mobility and not currently ambulant. Nil complaints of dizziness pain or shortness of breath. T: Assist physiotherapist with placing the patient on tilt table for treatment to improve WB through long bones and stimulating sensation of stand. A: The patient was transferred from the bed to the tilt table via slide sheet with 2 person assist. The patient’s blood pressure was taken at supine and interval levels of elevation on the tilt table. the patient’s blood pressure slightly dropped at ~ 45 degrees but then increased to 120/80. The patient was then elevated to ~85 degrees with blood pressure stable. Reaching to the left and right was then commenced. R: The patient managed for ~ 3min and then became unresponsive, clammy, gurgling and stiff. Blood pressure and oxygen levels were taken. Saturation levels were 97% RA via trache however blood pressure was ~96/58. The patient was immediately lowered to ~45 degrees and tracheostomy cuff was reinflated. The patient became responsive after ~5seconds. E: It is unclear what happened to the patient during this treatment session as the patient had previously managed well on the tilt table two times previously that week with no significant changes in blood pressure. The patient stated feeling fine when becoming responsive nil complaints from the patient. S: I turned to the physiotherapist for action during the incident and then enquired about what the procedure would be in that instance to initiate a MET call. The incident was clearly documented and I would know how to manage a situation in future from the advice and action of the physiotherapist.