UNCONSCIOUS!!

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UNCONSCIOUS!!

In which of the following compartments is the bleeding most likely to have developed?
A. Epidural space	Kamsi, Justice, peraspera, dermatology, Dr.D	5	45%
B. Subdural space	starcraftbw, usmle-china, Jasz98, phencyclidine	4	36%
C. Subarachnoid space		0	0%
D. Intracerebral	Sayulita	1	9%
E. Intraventricular		0	0%
11 votes

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usmlejedi
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09/09/07 - 09:30 AM

A 44-year-old man is brought unconscious to the emergency department 5 hours after a motor vehicle accident, in which he was ejected out of the car and hit his head on the pavement. He lost consciousness 3 hours following the trauma. On admission, the patient is unresponsive to verbal or painful stimuli, and his left pupil is fixed and dilated. X-ray films of his head show a closed left calvarial fracture. CT scan demonstrates evidence of intracranial bleeding. In which of the following compartments is the bleeding most likely to have developed?

A. Epidural space
B. Subdural space
C. Subarachnoid space
D. Intracerebral
E. Intraventricular

Kamsi
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09/09/07 - 11:32 AM

A

Epidural space

me007
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09/09/07 - 11:59 AM

could be epidural, but subdural is better bet - severe trauma, severe neurologic damage.

Justice
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09/09/07 - 12:26 PM

A. Epidural space

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kpmle2
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09/09/07 - 12:33 PM

A. Epidural space

elitoki
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09/09/07 - 02:39 PM

A. epidural.

Let me know if I'm wrong but... this is the way to differenciate

Head trauma--> loss of Consciousness --> recover--> loss again consc= Subdural
Head Trauma--> LOC (never fully recover) = Epidural

Sayulita
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09/09/07 - 02:56 PM

Well it is avery good question let me read it again.........mmmmmmmmm

let me see

Maybe intracranial=intracerebral

D

best guess ?

and if you do iknow the answer please tell us

Thanks for the post

me007
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09/09/07 - 03:30 PM

elitoki wrote:
A. epidural.

Let me know if I'm wrong but... this is the way to differenciate

Head trauma--> loss of Consciousness --> recover--> loss again consc= Subdural
Head Trauma--> LOC (never fully recover) = Epidural

are you sure that it is not vise versa?

elitoki
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09/09/07 - 03:52 PM

Sorry, it is inversa.
Head trauma--> loss of Consciousness --> recover--> loss again consc= epidural
Head Trauma--> LOC (never fully recover) = subdural

Thanks me007

What is the answer of this one?

liliaeliz
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09/11/07 - 12:59 PM

#10

starcraftbw
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09/11/07 - 03:06 PM

#11

usmle-china
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09/11/07 - 06:58 PM

#12

The Kaplan notes say," Big trauma, loss of Consciousness, the best bet is Subdural Bleeding"

Justice
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09/11/07 - 08:07 PM

#13

starcraftbw wrote:
F

???

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Justice
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09/11/07 - 08:09 PM

#14

In case of epidural bleeding, initial loss of consciousness may be absent or very short, per StepUp to Medicine textbook

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starcraftbw
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09/12/07 - 08:39 AM

#15

F = I'm not so sure sticking out tongue

peraspera
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09/12/07 - 03:36 PM

#16

At least 85% of Epidural hematomas are associated in patients have an ipsilateral " blown" pupil (dilated, fixed, nonreactive pupil on the side of the hematoma) A " lucid interval" of several minutes to hours before coma( unconscious) supervenes is most characteristic of epid. hemorr.
In Subdural hemorr.-up to one-third of patients have a lucid interval before coma, but most are drowsy or comatose from the moment of injury. A unilateral headache and slightly enlarged pupil on the same side are seen but not invariably found.
( Harrison's Int. Med.)

Dr.D
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09/24/07 - 06:06 PM

#17

A, closed left calvarial fracture/ lucid interval

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