Subdural/Epidural Hematomas

[matthewspear]

"These are classic signs of an epidural hematoma. you ned to prepare for seizures. PT's who have an epidural hematoma commonly seize. PT's who have subdural hematomas present with a deterioration in LOC, dilation of one pupil, abnormal respirations, rising BP and slowing pulse."

My question basically is - how do you tell the difference between subdural and epidural hematomas?

Thanks in advance guys.

 

[Rano Pano]

Some classic signs of an epidural hematoma are signs of ICP (dloc, severe h/a, unequal, dilated pupils, cushiness response) , aloc w lucid intervals, and the timing of when the SS begin to show - little as an hour-

Subdural can have the SS of an concussion, and ICP as well, but the timing of when the SS begin to show now can be a couple of weeks after the trauma.

 

[VFlutter]

The answer choices are misleading since both epidural and subdural hematomas are technically intracranial hemorrhages. But an epidural hematoma is caused by arterial bleeding where as subdural are venous. Epidural hematomas have a fast insidious onset and usually follow a pattern like the one described in the scenario. Head injury - brief loss of consciousness - lucid period - rapid deterioration. Subdural hematomas present with a gradual onset and slower deterioration of LOC. You likely would not see a blown pupil immediately after a head injury if it was subdural.

 

[EMT B]

I was under the impression you need a CT scan to definitively differentiate between the two.

 

[VFlutter]

I was under the impression you need a CT scan to definitively differentiate between the two.

You do but you can make an educated guess based on patient presentation just like any other differential diagnosis.

 

[FLdoc2011]

Definitely agree with the above. May not be able to tell on physical but the history may give a clue and lead you in one direction. We're taught the classic younger patient with a traumatic injury and brief LOC who then feels ok with a lucid interval and rapidly deteriorates a short while later vs the elderly one who bumps their head and then slowly deteriorates over the next few days.

That said, I've seen fairly acute traumatic subdurals that go downhill quickly.