Reposted from @archangeltacmed Head trauma - Brain Bleeds

Two of the most serious threats when it comes to head injuries are Epidural and Subdural Hematomas.

To better understand these bleeds, one must have a sound understanding of the basic anatomy of the brain.

Dura Matter - Is the outter lineing of the brain nearest the skull.

The Arachnoid Matter has all the blood vessels.

Pia matter covers the brain. This is usually considered the main portion of the brain.

Different head bleeds affect different areas of the brain.

An Epidural bleed happens between the skull and the dura matter. It is usually an arterial bleed. Because the skull has no way to relieve pressure it will build up quickly. This forms pockets of blood which is where it obtains its name, an Epidural Hematoma meaning above the dura. This is usually an acute quick onset after trauma and happens in younger adults.

A subdural hemotoma happens below the dura matter, usually into the arachnoid space. A Venus bleed that may devlop suddenly or over a longer amount of time, symptoms may develop in hours to days. If there is bleeding from a TBI, it is usually a Subdural Hemotoma. These happen to adults who are on blood thinners even from minor falls.

How does this affect your treatment in a prehospital setting? The truth is it doesn't. Without a CT scan, we can not diagnose in the field what type of bleed is occurring. Again we also are not in the business of diagnosing inuries. So your treatment is the same.

How can one tell the difference? Again it's hard to tell without a CT scanner but here are some considerations.

Quick/acute onset after injury - Epidural Slow gradual onset hours or days after injury is a Subdural Hemotoma.

Symptoms for both include; Severe headache "thunder-clap" Confusion Drowsiness Unequal pupils Alterd level of consciousness. Nausea and Vomiting Just to name a few.

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