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Epidural Hematoma, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Direct skull trauma

  • Inward bending of calvarium causes bleeding when dura separates from skull:

    • Middle meningeal artery is involved in bleed >50% of time.

    • Meningeal vein is involved ...

Diagnosis

Signs and Symptoms

History

  • Altered or deteriorating LOC

  • LOC: 85% will have at some point in course:

    • Only 11–30% will have a lucid interval.

  • Nausea and vomiting: 40%

  • Many times the only clinical si...

Treatment

Pre-Hospital

  • Head-injured patients have 25% improved mortality when triaged to regional trauma centers.

  • Spinal immobilization is essential.

  • Ensure adequate oxygenation throughout transport:

    • Intu...

Follow-Up

Disposition

Admission Criteria

  • All patients with CT abnormality or altered LOC should be admitted to ICU setting with frequent neurologic assessment.

  • Patients should have repeated CT exam in 12...

Additional Reading

  • Blythe  BJ, Bazarian  JJ. Traumatic alterations in consciousness. Traumatic brain injury. Emerg Med Clin North Am.  2010;28(3):571–597.

  • Chesnut  RM. Care of central nervous syst...

Codes

ICD9

  • 852.40 Extradural hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness

  • 852.41 Extradural hemorrhage following injury without mention of o...

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