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. He is unresponsive with the dilated right pupil when he reaches the emergency depament. The most impoant step in initial management is:
Answer is A (Craniotomy): Coma with a dilated pupil after a lucid interval following a head injury must be assumed to represent an epidural hematoma. Emergency evacuation of the clot without time-consuming studies is vital to restore cerebral function. With a patient in less critical condition, a CT scan is the appropriate diagnostic study.
Craniotomy
CT scan of the head
X-ray of the skull and cervical spine
Doppler ultrasound examination of the neck