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Epidural haematoma — MCCQE Part 1 MCQ

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ModerateTraumaEpidural haematomaMCCQE Part 1

22-year-old man presents with head injury with brief loss of consciousness. He has a lucid interval then worsening headache and a dilated pupil. Which of the following is the most appropriate next step?

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Correct answer: B — Urgently obtain CT head and neurosurgical involvement

Urgently obtain CT head and neurosurgical involvement is best because lucid interval and focal deterioration suggest epidural haematoma. Wait for confirmatory testing before any stabilisation is suboptimal because resuscitation and time-critical treatment should not wait when instability is present; Discharge once symptoms temporarily improve is suboptimal because temporary improvement can precede deterioration; Give an adjunctive medication as the sole first-line treatment is suboptimal because adjuncts do not replace definitive stabilisation; Delay escalation until cardiac arrest or respiratory failure occurs is suboptimal because early escalation is central to emergency care. Deteriorating neurological signs after trauma are not concussion.

Reference: Canadian CT Head Rule; neurosurgical guidance