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A 38-year-old male presents to the ED after a motorcycle accident where he was flung from his seat and hit his head on a nearby pole. He was not wearing a helmet. Miraculously, paramedics found him early without any other injuries, albeit unconscious. He is on a backboard, bag-mask ventilated with an oropharyngeal airway and a C-spine collar as he enters the trauma bay. His blood pressure is 140/80 mmHg, pulse is 100/min, respirations are 22/min, and SaO2 of 95% on room air. Glasgow Coma Scale score is 3, with the left pupil that is 3 mm more dilated than his right. He is endotracheally intubated, sedated with propofol, the head of his bed is risen to 30°, and hyperventilated to 30 breaths/min while mannitol infusions are prepared. Immediate head CT was as below.
What is the primary diagnosis and appropriate treatment?
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