A 19-year-old male was struck in the head during a hockey game. He briefly lost consciousness, regained alertness for a short period, and is now becoming increasingly drowsy and vomiting. His right pupil is dilated and nonreactive. Which condition should the nurse suspect?

A. Subdural hematoma is incorrect because subdural hematomas usually develop more gradually, particularly in younger patients. They often result from venous bleeding, and symptoms can appear over hours to days, rather than the rapid deterioration seen in this case. B. Epidural hematoma is correct because this scenario describes the classic “lucid interval” followed by rapid neurological deterioration. Epidural hematomas are typically caused by arterial bleeding, often from the middle meningeal artery after a temporal skull fracture. The sudden dilation of one pupil (ipsilateral to the hematoma) indicates uncal herniation, and symptoms such as vomiting, drowsiness, and increasing ICP are consistent with this neurological emergency. Immediate neurosurgical intervention is usually required. C. Intracerebral hemorrhage is incorrect because it involves bleeding within the brain tissue itself, often without the brief lucid period. It is more common in patients with hypertension, vascular malformations, or coagulopathy. The rapid, post-trauma lucid interval makes epidural hematoma more likely in this young trauma patient. D. Subarachnoid hemorrhage is incorrect because it usually presents with a sudden, severe “thunderclap” headache, often described as the worst headache of the patient’s life, sometimes with nuchal rigidity and photophobia. It is less commonly associated with trauma in young adults.