Epidural Haematoma

(Extradural Haematoma)

 <Presentations>

<Index>

 

Definition

-  Collection of blood between dura mater & bone (epidural space)

-  May occur intrcranially or in spinal cord

 

Features

-   

 

Cause

-  Epidural analgesia

 

Assocaited S/S

-  Headache

-  Nausea, vomiting

 

Complications

-  Seizure

 

DDx

-  Subdural Haematoma = cresenteric shaped on CT

-  Stroke

 

Ix

-  GCS

-  FBE

-  Blood Group & Hold

-  U&E

-  +/- Coagulation screen: INR, APTT

-  CT – Brain wo contrast

 

Mx

-   

-   

-  Intubation

-  If GCS <8

-  Consider if GCS <12

-  Elevate head to 30o & head in midline: optimise venous outflow

-  Decrease ICP

-  +/- Mannitol IV 0.25g/kg

-  +/- Mild hyperventilation: target pCO2 35mmHg (low normal): reduce ICP

-  Neurosurgery

-  Burr Hole

-   Temporising measure

-   Esp if herniation clinically evident

-   Start on side of first dilated pupil

-  Craniotomy: definitive

-   Cranial flap w clot evacuation

-   Control of bleeding sites 

 

 

 

References

 

ATLS Manual 2009