Physical examination of the head shows no signs of anemia or icterus.

This means that the rate of

which the red blood cells (RBCs) are broken down in the liver did not surpass the production rate
of new RBCs. Billirubin, a breakdown product of hemoglobin, did not accumulate in the body,
hence why the patient showed no signs of typical icterus such as yellowing of the skin or eyes.
Essentially, this means that the patient does not have any liver problem due to the trauma. No
blood accumulation is found in the ears as there is no laceration found in the scalp nor a fracture
found in the auditory canal, specifically in the external posterosuperior region. No findings of
bloody rhinorrhea also means that there are no direct trauma to the internal nasal cavity.
A positive bowel sound is found in the patient which is a normal case. This means that the
patient does not undergo intestinal paralysis and the gastrointestinal tract is working normally.
This is also shown by a positive tonus sphincter ani (TSA) test that shows a fully working tonic
contraction for anal closure. A positive bulbocavernosus reflex (BCR) test, referring to anal
sphincter contraction in response to squeezing the glans penis or tugging on the Foley may
indicate intact spinal reflex arcs (S2–S4 spinal segments) with afferent and efferent nerves
through the pudendal nerve.
The patient present with a respiratory rate of 24x/minute (normal:16-20x/minute), an increase
compared to its normal value rate due to intracranial bleeding with a volume of 1 cc. A
substantial amount of blood loss, such as one in this case, may result in hemodynamic
compromise occurring in the chest, abdomen, and retroperitoneum and can end up with a
hemorrhagic shock condition, due to a depleted amount of effectively distributing blood volume
in a body’s circulatory system. At this point, the body will not be able to match the tissue
demand for oxygen and will utilize anaerobic metabolism to meet the cellular demand and avoid
necrosis. This process will result in the production of ketones. In addition, the intravascular
volume loss will be compensated through increasing heart rate and its contractility. Hence, both
the patient’s blood pressure and respiratory rate increase beyond normal levels. Typically in this
condition, the patient will have a slightly increased diastolic pressure and a decreased sistolic
pressure, followed by a narrowing heart rate. However, the present case shows a blood pressure
of 137/76 mmHg, in which the diastolic pressure decreases by a little and a normal heart rate
84x/minute. However, The body’s compensation for this may vary by cardiopulmonary
comorbidities, age, and vasoactive medications.

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