NEUROLOGY + NEUROSURGERY
EPIDURAL HAEMORRHAGE
PromptCT interpretation
ResponseModerate left lateral convexity haematoma measuring 18mm in depth (?how they measure)
Associated undisplaced temporoparietal fracture
Mild mass effect 4mm midline shift
Swirl sign - represents ongoing active bleeding
Associated undisplaced temporoparietal fracture
Mild mass effect 4mm midline shift
Swirl sign - represents ongoing active bleeding
PromptManagement (specific to Epidural)
ResponseExtradural haemorrhage evacuation (Burr hole)
Other management (intubation, sedation etc. As per SAH mgmt)
Other management (intubation, sedation etc. As per SAH mgmt)
PromptManagement in rural hospital
ResponseAddress if burr hole can be done by gen surg
Retrieval to trauma service - time critical
Helo vs road - weather consideration/availability
Retrieval to trauma service - time critical
Helo vs road - weather consideration/availability
PromptDeterioration management - Hypertensive/bradycardic with single dilated pupil
ResponseHyperventilate
Sedate and optomise sedation
Osmotherapy - 3% saline or Mannitol
Urgent burr hole
Update receiving centre/neurosurgeon
Family update + discussion
Sedate and optomise sedation
Osmotherapy - 3% saline or Mannitol
Urgent burr hole
Update receiving centre/neurosurgeon
Family update + discussion
PromptSUBDURAL HAEMORRHAGE
Response
Prompt
ResponseRight parietal extradural haematoma (can describe bi-convex density and other features but need to say it is an EDH)
Air within EDH
Overlying scalp haematoma
Sub-arachnoid haematoma left frontal, likely contre-coup injury
Mass effect
Effacement of sulci right parietal
No appreciable mid-line shift
Air within EDH
Overlying scalp haematoma
Sub-arachnoid haematoma left frontal, likely contre-coup injury
Mass effect
Effacement of sulci right parietal
No appreciable mid-line shift
PromptManagement
ResponseNeuroprotection: as per intracranial bleed + Seek and treat rest of trauma.
Rupture of middle meningeal artery on temporal surface of skull