A 24- year old man falls on the ground when he is struck in the right temple by a baseball. While being driven to the hospital, he lapses into coma. On examination he is unresponsive with the dilated right pupil. Which of the following is the most impoant step in initial management?
Patient showing features such as coma with a dilated pupil after a lucid interval following a head injury is suffering from extradural hematoma. It is a neurosurgical emergency, as it will result in the death of the individual if the hematoma is not removed. Treatment of choice is urgent craniotomy. Ref: Bailey and Love's Sho Practice of Surgery, 24th Edition, Pages 597-8
Craniotomy
CT scan of the head
X-ray of the skull and cervical spine
Doppler ultrasound examination of the neck