An epidural hematoma, which is a life-threatening bleed on the surface of the brain, can happen if you fall while playing sports, get into a car accident, or hurt your head in a big way. The "lucid interval" is one of the most dangerous and misleading things about it. This is the time after the injury when the person seems fine, but then they get worse very quickly. An epidural hematoma is a real neurosurgical emergency, and every second counts. Emergency surgery in a hospital is the best way to treat this condition, but a Direct Primary Care (DPC) doctor can be a very important partner by quickly evaluating the situation and making sure the person gets the life-saving care they need right away.
An epidural hematoma is a pool of blood that forms in the "epidural space" between the skull and the dura mater, which is the tough outer layer of the brain. A skull fracture that tears an artery underneath it, usually the middle meningeal artery, is what usually causes it.
The Classic, Misleading Presentation: The "Clear Interval"
The story of an epidural hematoma is often very wrong and dangerous:
Someone gets hurt in the head and might or might not pass out for a short time.
After this, there is a period of time, from minutes to hours, when they seem to get better, feel pretty normal, and may even refuse medical help. This is the clear time.
Then, as the arterial blood quickly builds up and puts pressure on the brain, they get a bad headache, throw up, and become confused. They can quickly go into a coma and die.
A Race Against Time:
A hematoma in the epidural space is a medical emergency that could kill you. How quickly a neurosurgeon can relieve the pressure on the brain through surgery has a direct effect on the patient's chances of a good outcome.
Warning: Doctors who work in Direct Primary Care do not treat epidural hematomas. This is a neurosurgical emergency that needs to be treated in a hospital with an operating room and an intensive care unit. DPC's most important job is to quickly recognize problems, sort them out, and help people recover after surgery.
An "First Alert" System and Expert Triage After an Injury:
This is the most important thing a DPC doctor can do to save a life.
Immediate Access for Guidance: If you or someone else has a head injury, especially if it's a child or an older person on blood thinners, you can call or text your DPC doctor for help right away.
A High Level of Suspicion: Your DPC doctor knows how dangerous the "lucid interval" can be. If you call and say, "My daughter hit her head while playing soccer," Your DPC doctor will not tell you to wait if you say, "She seemed fine, but now she has a terrible headache and feels sick." They will tell you to call 911 or go to the nearest emergency room right away.
Avoiding a Deadly Delay: This expert triage from a trusted doctor can help a family resist the dangerous urge to "wait it out" at home, which could have tragic results.
A "Medical Home" for a Long and Complicated Recovery:
Getting through an epidural hematoma and brain surgery is just the start of a long road to recovery.
Your Recovery Quarterback: Your DPC doctor will be your main point of contact after you leave the hospital and go through rehabilitation. They work with your neurologist, neurosurgeon, and a group of physical, occupational, and speech therapists.
Taking care of the aftermath: They can help with headaches that happen after a traumatic event, keep an eye out for any seizure risk, and give the patient and their family the support they need for their many mental and social needs.
Case 1: The father of 17-year-old Ben, who plays hockey in high school, calls their DPC doctor. Ben got hit hard in the head during a game two hours ago. He was "shaken up," but at first he seemed fine. He is now complaining of a worse headache and has just thrown up. The DPC doctor tells him to hang up and call 911 right away, then go to the nearest trauma center. He knows that there is a chance of an epidural hematoma with a lucid interval. The quick evaluation finds an epidural hematoma, and Ben has surgery that saves his life.
Case 2: Maria, 50, is sent home from the hospital two weeks after surgery for an epidural hematoma caused by a fall. She is having a hard time with her new anti-seizure medications and all of her follow-up appointments. Her DPC doctor sees her for an hour, goes over all of her medications, makes a clear, organized list of all of her neurosurgery and therapy appointments, and puts her in touch with a brain injury support group in her area.
Q: I hit my head hard, but I didn't pass out. Is everything okay with me?
A: Not always. The "lucid interval" is the most dangerous and misleading part of an epidural hematoma. After the injury, you may feel fine for a while. If you have a serious head injury and your headache gets worse, you start throwing up, you get confused, or you feel sleepy, you should go to the doctor right away.
Q: Should I call my DPC doctor or 911 after hitting my head?
A: If you have a serious head injury, lose consciousness, or have any neurological symptoms that worry you, the safest and best first step is to call 911. Once you're on your way to the hospital, a family member can call your DPC doctor and tell them what's going on. After that, your DPC doctor can help you talk to the emergency team.
Q: What does my DPC doctor do if the neurosurgeon saved my life?
A: The neurosurgeon is the expert who does the surgery that saves lives. Your DPC doctor is the expert who knows what to do in an emergency and gets you to the surgeon right away. After the surgery, your DPC doctor will be your partner and coordinator for the long and often difficult process of recovery and rehabilitation.
If someone has hurt their head, having a DPC doctor is a clear benefit because:
Giving a "first alert" system that is very important: Because DPC is easy to reach and has a good relationship with patients and their families, they are more likely to call for help, which can save lives.
Stopping Deadly Delays in Care: A DPC doctor's knowledge can help a family resist the dangerous urge to "wait and see" when things are going well.
Providing coordinated, all-around recovery care: being the main "medical home" for a brain injury survivor to help them through their long, difficult recovery.
Every minute counts after a head injury. An epidural hematoma is a neurosurgical emergency that requires a quick, expert response to save a life and get a good result. You need a medical partner who can recognize the warning signs and act quickly. Direct Primary Care gives you quick access to care and expert triage to get you to life-saving care right away, as well as a caring partner to help you through your recovery.
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