Question

You are called to assist a 44-year-old male who was struck in the head with a large socket wrench at work. On arrival, the patient is conscious but confused; he complains he developed a sudden-onset severe headache moments after a wrench slipped off under pressure striking him in the temporal region of the skull. Co-workers state he was unconscious with abnormal posturing for about three minutes prior to EMS arrival. He states the headache went from the worst headache of his life to a dull throbbing headache and new-onset dizziness and nausea. His pupils are unequal with the right eye sluggish to respond while his grips remain equal but weak. As you continue your evaluation, he suddenly develops projectile vomiting and loses consciousness.

Which of the following injuries is most likely to cause his presentation?

A. Subdural hematoma
B. Epidural hematoma
C. Subarachnoid hematoma
D. Intracerebral hematoma

Answer 1

The most likely injury the patient who was struck in the head sustained is an Epidural hematoma. This condition aligns with his symptoms of a severe headache, confusion, unequal pupils, weak grips, projectile vomiting, and eventual unconsciousness after a momentary lucid period.

Step-by-step explanation:

Based on the clinical presentation of the 44-year-old male who was struck in the head and subsequently developed a severe headache, confusion, unequal pupils, weak grips, projectile vomiting, and loss of consciousness, the most likely injury he sustained is an Epidural hematoma (B). This type of hematoma is often caused by arterial bleeding between the inner table of the skull and the dura mater, commonly associated with a traumatic injury to the head, such as being struck with a socket wrench. The brief loss of consciousness followed by a lucid period and then rapid deterioration (as seen with the vomiting and unconsciousness) is a classic clinical scenario of an epidural hematoma. Additionally, a blow to the temporal region can result in a fracture of the skull overlying the middle meningeal artery, leading to a rapid accumulation of blood and increased intracranial pressure, creating the sluggish pupil response and other neurological symptoms.