Example Case

Thelma E. is a 84 y/o woman brought to the E.R. by her neighbor after a fall at home. She is alert and oriented, but somewhat stunned and upset by her fall. She also cannot recall exactly what happened. "I was fixing lunch, and the next thing I remember is Helen (the neighbor who happened to stop by) standing over me asking me if I was OK". Thelma's injuries from the fall at this point are unclear, she has extreme pain and tenderness in shoulder and a large and tender bump on her right forehead. At the moment there is no medical history, and Thelma reports she has not seen a doctor for the 12 years since her regular doctor retired. Her B/P is currently 190/110 and her pulse 96. Thelma's primary concern is not her physical state or injuries, but her husband Edward. Edward is now sitting quietly in the waiting room with the neighbor, but according to Thelma her husband "doesn't know who I am most days and he pretty much needs help with everything". What important points of information seem apparent here? What major questions do you have? What diagnostic procedures/activities would you recommend?