NEUROSURGICAL EMERGENCIES · MEMBERSHIP SURGERY

Extradural haematoma — 26M motorcyclist, lucid interval

12 decision points ~22 min Difficulty 4/5 Membership

Setting

You are the surgical registrar on-call at Korle Bu. CT is on-call within 30 minutes; neurosurgery is on-site for major cases but you may need to burr-hole in extremis; ICU + anaesthesia are activated.

Patient

Mr S, a 26-year-old motorcyclist, was involved in an RTA 40 minutes ago. He was reportedly unconscious briefly, then talking and complaining of a right temporal headache. On arrival he is deteriorating: GCS was 15, now 9 (E2 V3 M4). BP 158/92, HR 58, RR 12. Right pupil sluggish and dilating. Bruise over right temple. No obvious other injuries on primary survey.

Reference stack

Bailey & Love 28e Ch 37 · Sabiston 21e Ch 74 · Brain Trauma Foundation guidelines 4th ed 2016 · Marshall CT classification 1991 · ATLS 10th ed

Start cascade →

You'll be asked to decide what happens next at each step. There's no timer — take your time. The correct answer + evidence-anchored rationale is revealed after each choice.