A 31-year-old woman was struck by a van and brought to the emergency department unconscious with a Glasgow Coma Scale of 5/15, a blood pressure of 240/130, and a heart rate of 58. She has unequal pupils with a dilated and non-reactive left pupil, indicating possible increased intracranial pressure from internal bleeding seen on CT scan, requiring burr holes to relieve pressure.

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