The time when the patient is lucid and relatively alert is the period between
the recovery from the primary brain injury (usually a concussion) and the
onset of signs/symptoms of brain distortion/displacement by the hematoma.
When you know that a person has had a blow to the head and you see this
lucid period between periods of unconsciousness, suspect the presence of an
acute epidural hematoma.
(2) Acute subdural hematoma. An acute subdural hematoma is caused by
a high velocity impact. This type of hematoma comes from venous bleeding located
between the dura and the brain. The impact damages the underlying brain tissue.
Fluctuation in the level of consciousness.
Semiparesis (muscular weakness/ mild paralysis on one side of the
If surgery is performed less than 4 hours after the injury, the recovery rate for
a patient with intracranial hematoma is about 90 percent. If surgery is
performed more than 4 hours after the injury, the recovery rate is about 30
percent. Even a patient with acute intracranial hematoma has a better
chance of recovery with early operative treatment.
GENERAL NOTE: Generally, patients with head trauma injury should be
hyperventilated to get as much oxygen to the cells as possible and
to lower intracranial pressure (pressure within the skull).
GENERAL ASSESSMENT OF HEAD TRAUMA
Approximately 40 percent of serious trauma victims have central nervous system
injuries. This group has a death rate twice as high (35 percent versus 17 percent) as
that of victims without central nervous system injuries. Estimations are that head
injuries account for 25 percent of all trauma deaths and up to one-half of all motor
vehicle fatalities. The head-injured victim will rarely be cooperative and is often under
the influence of alcohol. When evaluating a patient with a head injury, always assume
that the patient also has a spinal cord injury.
a. Respiration. A head injury produces several types of abnormal respiratory
patterns. Possible abnormalities include:
A slowed respiratory rate caused by an acute rise in intracranial