review and comment

  Review the post below and respond . Your response must include your own conceptualization of the case, whether you agree or disagree with your peer’s response and why. You must use a minimum of one peer-reviewed source to support your response. 

This case is a 19-year-old male with 12 years of education who has worked in the field of construction successfully for the past 2 years. His girlfriend stated that he is often inattentive; she finds that he “spaces out” when they are talking and she frequently has to repeat information to him. He was involved in a car accident 6 months prior and sustained a very brief loss of consciousness, but his Glasgow Coma Scale at admission to the ED was 15/15. There was no evidence of pre- or post-traumatic amnesia.

I believe the patient is suffering posttraumatic brain injury. The brief unconsciousness is one of the major signs of a concussion. If the patient was willing or had the insurance to cover certain test the first thing I would suggest is a Magnetic Resonance Image. Not CT scan; CT scans are for harden parts of the body such as bones. Without the MRI or some other physical image of the patient’s brains, I would have to refer to the clinical or observed symptoms. The Center for Disease Control (CDC) lists the signs and symptoms and state symptom of concussions can be delay for days. The very first on their list is difficulty thinking clearly. (Center for Disease Control and Prevention, 2017) “Spacing out” and his inattentiveness is sign. TBI is not always obvious and can manifest the MRI would be necessary to check for swelling in the brain due to increased level of adenosine and glutamate in the traumatized brain tissue. (Carlson, 2012)
The patients’ age plays a critical role in recovery if treatment is administered once diagnosed. Several studies state age plays a role in how serve an effect of TBI can have on a patient. A study on predicting outcomes from complicated mild Traumatic Brain injuries studied male who suffered from injuries and were observed 3-6 months after their injury the study stated that there the models used for testing TBI had poor performance. (Lingsma, H. F., Yue, J. K., Maas, ..etc. 2015) This is another reason for my suggestion to ensure there is a MRI conducted. Because there are other connections to the brain and patients behavior such as occupation, daily functions, and emotional play a role in the variances of TBI outcomes it would best seek treatment. (Rassovsky, 2015) Without the MRI aging patients can have degenerative signs for years and they not be tied to TBI. For instance, Football players, Boxers, young patients without health care could have TBI and it go untreated until severe signs or symptoms appear such as depression. 
Because of his occupation and age, I would suggest that he be cleared by a neurologist or physician before returning. I would also ask the girlfriend (with his written consent) to write down and track any odd behaviors she witness as well as how often. I would ask for a follow-up appointment to after the test are completed and no later than 30 days from the date.
Some limiting factors or difficulties I see with my diagnosis and suggestion the patients insurance or coverage of treatment. There are no ethical issues at this time.
References:
Carlson, N. R. (2012, January). Tramatic Brain Disorder. In N. R. Carlson, hysiology of Behavior, 11th Edition. (pp. 526-528). Boston: Pearson Learning Solutions,. Retrieved from https://online.vitalsource.com/#/books/9781269952705/cfi/32!/4/2/16/50/[email protected]:92.6 (Links to an external site.)Links to an external site.
Center for Disease Control and Prevention. (2017, March 22). Traumatic Brain Injury & ConcussionBasic Information. Retrieved from CDC.gov: https://www.cdc.gov/traumaticbraininjury/symptoms.html (Links to an external site.)Links to an external site.
Lingsma, H. F., Yue, J. K., Maas, A. I. R., Steyerberg, E. W., Manley, G. T., Cooper, S. R., … Yuh, E. L. (2015). Outcome Prediction after Mild and Complicated Mild Traumatic Brain Injury: External Validation of Existing Models and Identification of New Predictors Using the TRACK-TBI Pilot Study. Journal of Neurotrauma, 32(2), 83–94. http://doi.org/10.1089/neu.2014.3384 (Links to an external site.)Links to an external site.
Rassovsky, Y. L.-K. (2015). Predicting long-term outcome following traumatic brain. Journal of Clinical and Experimental Neuropsychology, 354–366. Retrieved from http://eds.b.ebscohost.com.proxy-library.ashford.edu/eds/pdfviewer/pdfviewer?vid=5&sid=085509b9-e30e-4faa-8e59-1cda25e99242%40sessionmgr101 (Links to an external site.)Links to an external site.