A 31-year-old woman was struck by a van and brought to the ED responsive but lost consciousness. Her GCS was 5/15, BP was 240/130, HR was 58, and her left pupil was dilated and non-reactive on exam. She was initially responsive but lost consciousness due to head trauma from the accident. Her vital signs suggest she has increased intracranial pressure from a possible brain bleed. Her unequal and non-reactive left pupil is indicative of increased pressure on the left side of her brain.

1. Case discussion
• A 31-year-old woman was brought to the
ED after being struck by a van. She was
initially responsive but subsequently lost
consciousness.
• Her GCS was 5/15. Her BP is 240/130 and
HR is 58. Her pupils are unequal with a
dilated and non-reactive left pupil.

2. Questions
• She was initially responsive at the scene but
subsequently lost consciousness… explain
this phenomenon
• Her BP is 240/130 and HR is 58… discuss the
pathophysiology of the vital signs
• Her pupils are unequal with a dilated and
non-reactive left pupil… discuss the
pathological mechanism

3. Interpret the CT brain

4. List the 4 indications of
burr holes
1.
2.
3.
4.

5. Site of burr hole