 Hi, welcome to nursing school explain in this video on epidural and subdural hematoma. While they are both similar and caused by head injuries, they might be different and it's very important to know what distinguishes them. But first of all, let's review the anatomy here. So we have the head that's protected by our skull and inside there are several layers that are designed to protect the brain. Now the first layer underneath in blue is the duramatter and then underneath that we have the subarachnoid membrane and then below that we have the pia matter which just lines the immediate surface of the brain. So now depending on where the bleeding occurs is an epidural above the duramatter or a subdural below the duramatter hematoma, a bleeding. Now I've also drawn out here a subarachnoid hemorrhage which is below that subarachnoid membrane or an intracranial hemorrhage which is within the brain. All four of those really cause increase in intracranial pressure but depending on the layer and what causes it or what type of bleeding causes it, the patient might have different symptoms. So keep in mind that any kind of trauma to the head can cause bleeding inside the head so that most of them occur due to motor vehicle crashes or falls and specifically older patients have an increased risk because their brain atrophies over time so there's a lot more room for the brain to be jarred around if there is a fall and therefore there are increased risk because of falls. And so the other drawing that I have here is that we need to keep in mind that in our head in our cranial cavity there are three compartments which first we have the brain that consists about 78 percent of the intracranial contents. We have blood all the blood vessels that supply the brain and then we have cerebral spinal fluid which is about 10 percent and our bodies are designed in such a way that the skull protects the head from outside injury which is a nice design but now if one of those compartments brain blood or CSF takes up too much space there's nowhere else for the other compartments to go because the skull is a closed cavity which is why in children when they have increased intracranial pressure and their sutures, their fontanelles have not fused yet you might see bulging fontanelles so now the brain has somewhere to move but in adults or once the fontanelles have closed the brain really has nowhere to go if there is a bleed let's say so now there is a big hematoma in there the brain might shift to one side or the other which then leads to increased intracranial pressure and I'll have a separate video about intracranial pressure and how to manage that so now let's focus on subdural and epidural hematoma so over here an epidural hematoma occurs like we said above the dura mater in the brain it is a neurologic emergency because it is a blood vessel tear and it usually is an artery that ruptures and recall that arteries are much higher pressure than veins and so the bleeding occurs much faster than it would and so the blood the bleeding rapidly expands and the tale tale signs and symptoms is that there is some sort of a traumatic injury on the scene if somebody observed it there is a positive loss of consciousness so the patient loses their consciousness and then they have a brief lucid period where they appear to be completely abnormal and then all of a sudden their level of consciousness decreases again so that is kind of the tale tale signed because of this arterial bleeding and as with any kind of intracranial pathology there might be a headache there might be nausea and vomiting as the meninges get irritated treatment for an epidural hematoma it's an arterial bleed so we need to stop the bleeding so it involves rapid surgical intervention to evacuate the hematoma and prevent herniation and herniation basically happens so when now we have a bleed like over here we have this epidural hematoma on the left side if we had that here that would mean that the brain moves over or gets pushed over towards the other side because that blood the bleeding now is taking up too much space and when there's the bleeding extends then the brain can only move so far and then eventually it will get pushed down on the brain stem and then there will be basically dire consequences as the main the basic functions that the brain stem controls start to cease not working anymore and i'll go over that in the intracranial pressure video so rapid surgical intervention is needed to evacuate that hematoma that usually involves a kerinolomy so basically drilling a hole inside the skull and draining that blood out and then manage the intracranial pressure and like i said you can wash it in a different video now in contrast the subdural hematoma is an injury to the brain tissue and the blood vessels and those are usually venous you know in origin that means that the bleeding usually occurs a little bit slower that doesn't mean that subdural hematomas are not as dangerous as epidural hematomas but because the bleeding occurs a little bit slower we have a little bit more time to treat the patient and detect this when an epidural hematoma just is an arterial bleed that rapidly expands really we only have a maybe an hour or two to get this patient to the OR to get this epidural hematoma evacuated otherwise they are basically going to be brain dead and for subdural hematoma we have to distinguish between acute subacute and chronic and that basically just means the when the hematoma occurs and the symptoms that you'll see so acute is between 24 to 48 hours after injury subacute is in between two to 14 days and chronic can be weeks or months after what might only seem to be a minor head injury so this might be an older person getting inside the car bump in the head on the car door they are fine initially but then maybe weeks down the road they start to develop decreased level of consciousness or some very strange symptoms while it turns out that they had a very small blood vessel that ruptured that just slowly leaked inside their brain or inside that subdural space and now they're exhibiting signs and symptoms and like I stated before older adults and also patients with alcoholism are an increased risk for subdural hematomers specifically the chronic ones because their brain tends to be atrophied so again when the brain gets jarred inside the skull there's a lot more room for it to move around and a lot more chance for these blood vessels to rupture signs and symptoms for subdural hematoma include signs and symptoms of intracranial pressure decreased level of consciousness and again headache nausea and or vomiting now treatment because it depends on how significant and how big the bleeding is might range from what for waiting to evacuation of the hematoma like we saw the epidural hematoma and a lot of times these are patients that get admitted to the hospital with a small subdural hematoma they might not have any neurological signs and so they get admitted and they get repeated CAT scans maybe initially every four hours and maybe after the fact every day to see is it expanding is it shrinking is it staying the same can we just watch this and observe the patient very closely or do we have to eventually treat it and evacuate it and again here we want to manage the increased ICP now for nursing care in general for patients with any of these epidural or subdural hematomas we want to maintain cerebral oxygenation and perfusion and that really depends on the cerebral perfusion pressure and please watch my separate video that goes into the details of how to obtain that and then we want to do frequent neural checks and Glasgow coma scale as well as the entire cranial nerve and peripheral neurovascular assessments to see is the patient getting better worse or staying the same and then frequent monitoring of vital signs and the temperature is especially important to monitor if there is an injury to the hypothalamus because again that is the center of the brain that regulates the temperature and if there's an injury it might not be working appropriately and the patient might have very spiking or low body temperatures that you can that you could maybe mistaken for other things like infection so we need to very closely monitor the vital signs and then we need to check for CSF cerebral spinal fluid, otorrhea and rhinorrhea and rhea always means just fluid coming and otto either from the ears or rhino from the nose and so that means that CSF could be leaking out of the patient's nose or ears and that would be if there's an interruption to the skull or to the to the meninges that that protect the brain because the CSF usually shouldn't be coming out of the nose and ears and the way we do that is the patient all of a sudden you know has nasal drainage or ear drainage then you could collect that with a piece of gauze and then there will be the the what's called the halo sign so if you put and a lot of times it won't be just clear fluid it will be mixed with blood so you put that on a piece of gauze and then in the middle you can see that there is blood and then around it the CSF will separate and will make a halo around that piece around that drop of blood or that area of blood that's in the middle and that's a very of course informal test so if we're really concerned about that we need to collect some of that fluid and send it off to the lab for analysis to see if it's really a cerebral spinal fluid and then of course if there is maybe an infection associated with it because now if we have this interruption of the meninges and all these layers that protect the brain that are intended to protect the brain and now cerebral spinal fluid is leaking out foreign bodies bacteria viruses can get in there and then causing um meningitis so that would be a major concern here so if we witness the CSF otorrhea or rhinorrhea we definitely cannot pack the nose or ears we don't want to pack anything in there and then basically just pushing that CSF back because it might increase our intracranial pressure we definitely don't want to place an NG tube in there if there is drainage from the nose we will be very very careful with suction or we don't want to perform any kind of nasal suctioning and again because there's this risk for meningitis so hopefully this video has helped you determine between epidural arterial and subdural more venous type bleeding inside the brain that's caused by any kind of head injuries please also watch the video on increased intracranial pressure as well as intracranial pressure and cerebral perfusion pressure and how those two relate to one another to maintain the patient's neurologic status please give me a thumbs up if you've enjoyed this video subscribe to my channel follow me on instagram to stay up to date on the latest releases thanks for watching