Trauma I

Question 1

14 yr old boy hit over the rights side of the head with a baseball bat. Loses consciousness for a few minutes, recovers and is fine, then passes out again one hour later. Fixed right pupil and dilated.

Answer 1

Epidural hematoma

Question 2

How is an epidural hematoma diagnosed?

Answer 2

CT scan

Question 3

How is an epidural hematoma treated?

Answer 3

Emergency craniotomy. Good prognosis

Question 4

32 yr old male with head-on high speed collision. Unconscious at site, regains consciousness briefly, then arrives at ER in deep coma. Fixed, dilated right pupil

Answer 4

Subdural hematoma (or epidural)

Question 5

How is a subdural hematoma diagnosed?

Answer 5

CT scan

Question 6

How is a subdural hematoma treated?

Answer 6

Emergency craniotomy. Poor prognosis

Question 7

77 yr old male becomes “Senile” over a period of 3-4 weeks. Used to be active and managed all of his financial affairs. Now stares at wall, barely talks, sleeps most of day. Fell from horse 1 week before mental changes.

Answer 7

Chronic subdural hematoma (size seven brain size eight skull)
venous bleeding

Question 8

How is chronic subdural hmtma dxd?

Answer 8

CT scan

Question 9

How is a chronic subdural hematoma treated?

Answer 9

Craniotomy. Spectacular improvement expected

Question 10

Car hits pedestrian. Arrives in coma. Raccoon eyes. Clear fluid from nose or ear or ecchymosis behind ear.

Answer 10

Basal skull fracture.

Question 11

How is a basal skull fx diagnosed?

Answer 11

CT scan. Needs cervical spine X-rays

Question 12

Implications for therapy for basal skull fx

Answer 12

Neurosurgical consult, needs abx