13-mm Midline Shift in Surgery — 72yo Man | Neurosurgery | SMLE Q#778

SMLE Question #778

Surgery Neurosurgery
A 72-year-old man is brought to the emergency department after a fall from standing height and an unknown period of unconsciousness. He is confused and becoming less responsive. Neurologic examination shows GCS 7/15 (E2, V1, M4), a dilated, poorly reactive left pupil, and right-sided weakness. Head CT shows an acute left subdural hematoma with 13-mm midline shift and compression of the left lateral ventricle. After initial stabilization in the ED, what is the most appropriate next step in management?

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