Epidural Hematoma Management in the ED Medication

Updated: Dec 10, 2021
  • Author: Daniel D Price, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
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Medication Summary

Use rapid sequence induction (RSI) when intubating to minimize increases in ICP and catecholamine release. Etomidate, when used as an RSI sedating agent, maintains blood pressure, lowers ICP and brain metabolism, and has rapid onset and brief duration. Thiopental is not recommended because of its predictable effect in lowering blood pressure (elevated blood pressure is the leading cause of secondary brain injury). Mannitol osmotically reduces ICP and improves blood flow. Phenytoin provides prophylaxis against early posttraumatic seizure. Once the patient has received adequate fluids, pressors such as norepinephrine can be used to maintain MAP > 90 mm Hg.


Osmotic diuretic

Class Summary

Osmotically reduces brain edema and ICP and reduces blood viscosity, improving cerebral blood flow and oxygen delivery. Prior to ICP monitoring, use only for signs of herniation or progressive neurological deterioration. Hypovolemia should be avoided by replacing fluids (urine monitoring with placement of a bladder catheter is essential). Intermittent boluses may be more effective than continuous infusion.

Mannitol (Osmitrol)

Keeps serum osmolality < 320 mOsm to prevent renal failure. Maintain euvolemia with adequate IV fluid replacement. Foley catheter is essential.



Class Summary

Prevents early posttraumatic seizure, which can increase ICP and neurotransmitter release as well as alter blood pressure and oxygen delivery.

Phenytoin (Dilantin)

DOC for seizure prophylaxis. Fosphenytoin allows more rapid infusion and fewer side effects. If actively seizing, coadminister benzodiazepine.