extradural haematoma

Question 1

21 y.o. man has been in a fight outside a pub

he received at least one blow to the left side of his head from a baseball bat

(a) he localises and opens his eyes to pain. he has incoherent speech.

(i) what is the breakdown of his GCS?

(ii) what is his GCS?

Answer 1

(i) eyes 2/4, verbal 2/5, motor 5/6
(ii) total score 9/15

Question 2

(b) (i) what urgent ix does he need?

Answer 2

head CT

Question 3

(b) (ii) what precaution needs to be taken first?

Answer 3

secure the airway

Question 4

(c) in the context of an intracerebral injury, what is coning?

Answer 4

coning refers to a tonsillar herniation

i.e. when raised ICP causes cerebellar tonsils to move downward through the foramen magnum and press on the brainstem causing potentially fatal respiratory and cardiac dysfunction

Question 5

(d) you suspect an extradural haematoma (EDH).

describe 3 signs of an expanding EDH as it enlarges, but before it results in coning

Answer 5

1. decreasing levels of consciousness (decreased GCS)
2. CN III palsy (i.e. non-reacting dilated pupil looking down and out)
3. left papilloedema
4. increasing agitation
5. worsening headache
6. nausea and vomiting
7. focal neurological signs