New Left Arm in Surgery — 8yo Child | Pediatric Surgery | SMLE Q#11957

SMLE Question #11957

Surgery Pediatric Surgery

Objective: OBJ-1758

Last updated: February 2026
An 8-year-old boy is brought to the emergency department after a metal gate struck the right side of his head. He was briefly stunned, then initially conversant. Over 30 minutes, he became progressively somnolent. Two hours after injury, he is drowsy with new left arm and leg weakness. Exam shows a large tender right temporal scalp swelling, a right fixed dilated pupil, and left hemiparesis. Non-contrast head CT shows a right biconvex hyperdense extra-axial collection with midline shift. What is the most appropriate next step in management?

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