To the Hon Casualty Consultant
Thank you for accepting this patient for review in A&E.
He is a 33 year old unemployed man,who lives with his teenage daughter.He is a smoker and describes himself as a social drinker.
He reports no significant or relevant previous medical history;reports no daily medication;and has no allergies.
He told me that he was cycling down his road this morning when he saw his best friend driving his car down the same road towards him...and that my patient decided to "play a joke" on his friend and decided to cycle directly into the path of his friends' car.
It was raining with poor visibility.
All was going according to plan until he tried to bring his bicycle to a sudden stop...and his brakes failed and he hit the bonnet of his friends' car and went over the top of the car,and landed on the road,hitting the left side of his head in the process.
There was no damage to the road.
He was not wearing a helmet.
He is tender over his left mastoid and has a lacerated ear.
He went home to lay down for a while as he felt unwell.At some point this afternoon his teenage daughter returned home and found him unconscious on the floor of lounge;she phoned his friend (into whose car he had crashed) and they brought him to our Minor Injuries Unit for treatment.
In the fifteen minutes between ShufflingBob doing the initial 'head injury observations' and my examination of him,I found that his left pupil was larger than his right pupil;and was in fact non reactive to light.
I decided to monitor his vital signs whilst we were waiting for the emergency ambulance;and found he had a heart rate of 143 and a blood pressure of 140/110.
He was also becoming disoriented.
At this point he told me that he is a frequent amphetamine user;and that he had taken a large amount of cocaine earlier that morning.
We decided to do an ECG and found significant changes indicating he had had a heart attack.
BTW,I have torn up his organ donor card since there is no part of him that would be useful to mankind.