Now intubated and ventilated without difficulty, and wheeled round to the scanner. She is about to
be scanned, when she suddenly develops a sinus bradycardia. Things are happening too fast to look
in pupils and so on, and she has to be scanned and sorted later. Scan reveals a massive hyperacute
extradural (I was planning to append some pictures as this is the largest I have ever seen but they
have "vanished".) which fills all the temporal region on the left and extends right up to the vertex.
There is marked midline shift, and the right lateral ventricle has been obliterated. Neurosurgery is in
another hospital 30 miles away.
What is happening?
How do you manage her now?
Best wishes,
Rowley Cottingham
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http://www.emergencyunit.com
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