In the case study provided, the unconscious 82-year-old woman needs an assessment and differential diagnosis so that paramedics know how to treat and determine if the patient is on time or critical transport. A differential diagnosis is based on paramedic training, the patient's history, current vital signs, and relevant knowledge gained from those at the scene. The paramedic must, after the differential diagnosis, understand the pathophysiological process and how it affects the patient. The patient suffers from an acquired brain injury (ABI), which is an injury occurring after birth (Victoria Government, 2013). The patient also suffers from a traumatic brain injury (TBI), caused by physical force resulting in brain damage. One aspect of seeking a differential diagnosis is understanding the mechanism and type of injury (MOI/POI). When looking at brain injuries, the MOI/POI can be separated into two parts, primary and secondary injuries. The primary injury is that which occurs at the time of impact, that is, the table which causes a visible hematoma (Rosenfeld, 2012). Secondary injury is a cascade of events and medical conditions that can aggravate the primary injury (Hughes and Cruickshank, 2011). In this patient's case, it was the chronic subdural hematoma that caused secondary conditions, such as Cushing's reflex, that caused the patient to lose consciousness. Looking at the patients' vital signs, they are steadily deteriorating and are worrying for an 82 year old man. female. The patients' heart rate starts out low but within the normal range, but within 15 minutes it drops to 54 bpm, which is within the bradicardia range (Curtis, Ramsden & Lord, 2011). T...... middle of paper ......a Pty Ltd., (2014). Avapro HCT. Retrieved from https://www.mimsonline.com.auNational Health Service (NHS)., (2013). Causes of subdural hematoma. Retrieved from http://www.nhs.uk/Conditions/Subdural-haematoma/Pages/Causes.aspxPlaha, P., Malhotra, Dr., Heuer, Dr. and Whitfield, P. (2008). Management of chronic subdural hematoma. Advances in Clinical Neuroscience (ANCR), 8 (5), 12-15. Retrieved from http://www.acnr.co.ukProfessional Health Systems., (2014). Vital signs chart. Retrieved from http://prohealthsys.com/site/resources/assessment/physical-assessment/vital-signs/vital_signs_table/Rosenfeld, VJ, (2012). Convenient management of head and neck injuries. Chatswood, NSW: Elsevier Australia. Victorian Government., (2013). Acquired brain injury. Retrieved from http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Acquired_brain_injury?open