Fall at home with a knock to the head in an older man
AMC Clinical practice station

The task

You are a doctor in a general practice. Mr George Hartley, aged 78, was driven here by a neighbour about 90 minutes after he fell at home and hit his head. He says it is only a bump and he needs a lift home because his wife is on her own. Take a focused history, ask for any examination you consider necessary, and explain to Mr Hartley what you recommend. If you would phone another service, say aloud what you would tell them. Examination findings will be given on request. The examiner will not take part in the conversation.

What this station tests

• Anticoagulants raise the risk of delayed intracranial bleeding; a head injury on a blood thinner needs a CT scan even when the patient looks well.
• Ask the time of the last dose of the anticoagulant and include it in the handover.
• Use 000 for transport; a patient with a head injury and vomiting should not walk out or be driven home.
• A carer is also a patient's risk: arrange care for the dependant early.
• Respect autonomy by explaining your reasoning and checking understanding.

Sources for the clinical content

• Victorian State Trauma System: Traumatic brain injury, early management
• Healthdirect: Head injuries
• Triple Zero Australia: when to call 000
• ACSQHC: Communicating for Safety Standard

An original practice scenario with invented patients. Not an exam question.

Practise next

• Fever and abdominal pain after bowel surgery
• Collapse in the waiting room