Two physicians are finishing their rounds when a paramedicbrings a patient in the emergency room. The senior paramedic, JimMorrison, reported that the patient was swimming at the localquarry and did a forward flip into the water, striking somesubmerged rocks. \"Which part of his body struck the rocks?\" askedDr. Carter. \"He was in a hyperflexed-tucked-position when he hitthe rocks, lacerating the right side of his head and neck and upperback. The patient indicated he had severe pain upon impact and lossof sensation and movement in his arm and leg. He may have lostconsciousness, but he's not sure. He also complains of a severeheadache, dizziness, and nausea. When we arrived at the scene weimmobilized, stabilized and transported him immediately,\" Jimexplained. Looking at the patient, Jim continued. \"His name is MikeSmith, and he's 22 years of age. His vital signs include slightlylowered blood pressure (100/70), heart rate of 75 beats per minute,respiration normal, and he is conscious and alert.\" As the patientwas being prepped for examination, Dr. Carter and Dr. Greendiscussed how they should approach their evaluation. Dr. Carterstarted by saying,\"After seeing the head wound and the amount ofblood loss, and hearing his complaints, I want to confirm mysuspicion that this patient has a brain injury.\" Dr. Greendisagreed: \"I think that the other signs and symptoms indicate aspinal cord injury, and that's what we should investigate.\" Thefollowing table summarizes the findings of the evaluation, whichincluded a physical exam, X-rays, magnetic resonance imaging (MRI),and neurological tests.
Summary of Diagnostic Testing for Mike Smith
Sensory Testing -Decreased sensation to touch, pressure, andvibration in the right upper/lower extremities -Decreasedtemperature discrimination (cold vs. warm) in the left upper/lowerextremities
Motor Testing -Decreased strength and movement of the rightupper/lower extremities during muscle testing -Decreased strengthand movement of left abdominal muscles -Absence of triceps andbiceps reflexes in the right upper extremity -Abnormal response ofpatellar, Achilles (hyper) reflexes in the right lower extremity-Positive Babinski sign on the right foot -Abnormal cremastericreflex in the right groin region
General Examination -Abnormal pupil response of right eye(constriction) -Other vital signs within normal limits -Cognitivetesting normal (counts backward from 100 by 7s; knows name, date,place) X-Ray and MRI Examination -No fractures present in the skull-Fracture in the 7th cervical vertebra -Significant swellingpresent in the spinal canal in the C7-T2 region Spinal cord appearsto be intact
Which of the Doctors (Carter or Green) are correct with thediagnosis. Please, explain why you chose one or theother.