After a fall two weeks ago in which Betty hit her head on a table, Betty suffered a 4cm hematoma. The fall appears to have caused a traumatic brain injury (TBI); Based on the information it appears that Betty may have an external hematoma, a brain contusion and an intracranial hemorrhage. Fall-related injuries cost the Australian healthcare system more than any other injury. More than 25% of Australia's older population (aged 65 and over) is expected to experience declines. Falls account for over 50% of traumatic brain injuries in people over the age of 65 (NSW Government; Population Health, 2011). The number of risk factors for a fall increases with age, therefore making the older population more susceptible to having a fall (Thompson, McCormick, & Kagan, 2006). In Betty's case the mechanism of injury is vertical deceleration. Betty tripped on a mat and hit her head on a table, as she hit her head this would provide the coup mechanism which would cause the brain to hit the front of the skull, the motion of the counterblow is the motion of the brain that is pushed into the back of the skull. the skull (Medicallegalart, 2011). Injury pattern refers to the pathophysiological changes that occur after injury. Given Betty's worsening in the fifteen minutes between the first vital sign reading and the second, in light of the Cushing's reflex, it is possible that Betty's fall caused a brain hematoma and that her intracranial pressure (ICP) was rising . The Cushing reflex is the hypothalamic response to increased intracranial pressure, and increased intracranial pressure causes poor perfusion and cerebral ischemia, resulting in an altered level of consciousness. The reflex causes the clinical symptoms of Cushing's triad, which...... half of paper ......14, from http://www.betterhealth.vic.gov.au/bhcv2/bhcmed.nsf/ pages/swcavhct/$File/swcavhct.pdfThompson, H. J., McCormick, W. C., & Kagan, S. H. (2006). Traumatic brain injury in older adults: epidemiology, outcomes, and future implications: TRAUMATIC BRAIN INJURY AND OLDER ADULTS. Journal of the American Geriatrics Society, 54(10), 1590-1595. doi:10.1111/j.1532-5415.2006.00894.xTien, H. C., Cunha, J. R., Wu, S. N., Chughtai, T., Tremblay, L. N., Brenneman, F. D., & Rizoli, S. B. (2006). Do trauma patients with a Glasgow Coma Scale score of 3 and bilateral fixed and dilated pupils have any chance of survival? Journal of Trauma-injury Infection and Critical Care, 60(2), 274-278. doi:10.1097/01.ta.0000197177.13379.f4Tintinalli, J.E., Cline, D., and American College of Emergency Physicians (2012). Manual of Emergency Medicine Tintinalli. New York: McGraw-Hill Medical.