A trauma patient presents with two episodes of vomiting and loss of consciousness. CT brain shows a biconvex hyperdense lesion. What is the next step in management?

1. A

   Craniectomy

2. B

   ICU observation

3. C

   Conservative management

4. D

   Burr hole and evacuation

Appeared in: INI-CET EXAM -2025

Explanation

• The patient's CT scan shows a biconvex hyperdense lesion, which is the classic radiological sign of an Extradural Hematoma (EDH).
• The presence of vomiting and loss of consciousness indicates significant and rising intracranial pressure (ICP), which is a neurosurgical emergency.
• Burr hole and evacuation is the immediate, life-saving surgical procedure to drain the arterial bleed, decompress the brain, and prevent herniation.
• Delaying surgical intervention in a symptomatic EDH can lead to irreversible brain damage or death.

Why Other Options Were Wrong

• Option A: Craniectomy is a more extensive procedure where a portion of the skull is removed. While it can be used for large hematomas with significant brain swelling, a burr hole is a faster, more direct initial step for emergency decompression of an EDH.
• Option B: ICU observation is only appropriate for patients with very small, asymptomatic EDHs who are neurologically stable. This patient is symptomatic with loss of consciousness, making observation dangerously inappropriate.
• Option C: Conservative management is synonymous with observation and is not a safe option for a patient with neurological compromise due to brain compression from a hematoma.

Related Visual

• Visual 1: CT Scan of Head - An axial view showing a classic biconvex (lens-shaped), hyperdense collection of blood adjacent to the skull, characteristic of an extradural hematoma.
• Visual 2: Diagram of Surgical Procedures - A simplified illustration comparing a burr hole (a small hole drilled in the skull) versus a craniotomy/craniectomy (removal of a larger bone flap) for hematoma evacuation.

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Management of Extradural Hematoma (EDH) in acute care settings.
• A nurse's primary role in this scenario is rapid and continuous neurological assessment using tools like the Glasgow Coma Scale (GCS). Any deterioration, such as a drop in GCS, new pupillary changes (e.g., anisocoria), or worsening headache, must be immediately communicated to the neurosurgical team.
• The nurse must prepare the patient for emergency surgery, which includes ensuring IV access, obtaining consent (if possible), and coordinating with the operating room and anesthesia teams. Time is critical.
• Post-operatively, the nurse will monitor for signs of re-bleeding, infection, seizures, and changes in ICP, managing drains and providing critical care support.

How to Approach the Question

• First, analyze the clinical information provided. 'Trauma', 'vomiting', and 'loss of consciousness' are key indicators of a serious head injury.
• Next, interpret the imaging finding. 'Biconvex hyperdense lesion' is a textbook description. You must immediately identify this as an Extradural Hematoma (EDH).
• Connect the symptoms to the diagnosis. The patient's neurological decline (loss of consciousness) is a direct result of the EDH causing increased intracranial pressure.
• Evaluate the options based on urgency. An EDH with neurological symptoms is a surgical emergency. This rules out conservative options like observation.
• Differentiate between the surgical options. 'Burr hole and evacuation' is the most direct and rapid emergency procedure to relieve pressure from an EDH. While a craniectomy is a neurosurgical procedure, the burr hole is the classic initial step for this specific emergency.

Concept Tested & Keywords

• Concept Tested: Management of Extradural Hematoma (EDH)
• Stem keywords: trauma patient, vomiting, loss of consciousness, CT brain, biconvex hyperdense lesion
• Lead-in keywords: next step in management
• Clinical cues: Biconvex hyperdense lesion on CT is a classic sign of Extradural Hematoma (EDH).
• Clinical cues: Loss of consciousness is a red flag for increased intracranial pressure (ICP) and neurological compromise.

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