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THE ANATOMY
BLUNT
1. HIGH
VELOCITY
2. LOW
VELOCITY
Mechanis
m of
Injury
IMPACT
PENETRAT
ING
1. STAB
WOUND
2. GUN
SHOT
3. OTHERS
EPIDURAL HEMATOMA
PATHOPHYSIOLOGY
COMPRESSION-MIDLINE
SHIFT & MASS EFFECT
SYMPTOMS AND SIGNS
CLINICAL FINDING
10-27% have this classical
presentation :
Brief post traumatic loss of
consciousness (LOC) followed by a
Lucid interval for several hour.
Then, obtundation, contralateral
hemiparesis, ipsilateral pupillary
dilatation
Headache
Vomiting
Seizure
Ipsilateral dilated pupil
Contralateral hemiparesis. But ipsilateral
hemiparesis may occur (Kernohans
phenomenon), a false localizing sign
Bradicardia is a late findings
Hypovolemia may be present in infant
HOW TO DIAGNOSE ?
1.
TREATMENT
A, B, C, D
2. Oxygenation
3. Head up 300
4. IVFD
5. Analgetic
6. Antibiotic if necessary
7. Anticonvulsant prophylactic
8. H-2 Blocker
9. NGT, Foley Catheter
10. Determine : Conservative or Surgical ?
1.
TREATMENT
NON SURGICAL, If :
Small lession (< / = 1 cm maximal
thickness) non acute EDH with minimal
neurological signs/symptoms and no
evidence of herniation
Volume < 30 cm 3
Mid line shift < 5 mm
GCS > 8
No focal neurologic defisit
SURGICAL BY CRANIOTOMY
EVACUATION, If :
Signs of local mass effect, signs of
herniation (increasing drowsiness, pupil
changes, hemiparesis,), or
cardiorespiratory abnormality.
Strongly recommended in acute EDH &
GCS < 9 and anisocoria
Pressing in
externa
table of the
skull at the
site of injury
Strain force
of internal
table
FRACTURE
Force
increase
exceeds the
capability of
bone
deformation
SIGNS/SYMPTOMS
Headache
LOC
Mass effect
Compression effect
Signs Infection, locally or systemic
Open (Compound)
a. There is no evidence of dural penetration
(clinically or CT). Ex, CSF leak
b. No significant intracranial hematoma
c. Depression is < 1 cm
d. No frontal sinus involvement
e. No wound infection or gross contamination
f. No gross cosmetic deformity