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Sat Nov 4 21:20:52 GMT 2006

In a message dated 11/4/2006 1:13:19 PM Central Standard Time,  
tangentcarrot at hotmail.com writes:

Well, we  got to the nearest hospital, which is  has no nerosurgical  
capabilities. The pateint is attended by a physician (general surgeon?)  
about 10 min later. In that point, his brother was told by an eye witness  
that he was defiently struck.The pateint later starts to complain about  
local pain in the back of the head which feels like he was struck  there.  It 
takes over an hour since arrival for a nuerologist to  attend him. All along 
he is shivering, and continues to have  amnesia.
Second dilema- should such a patient  immediatly be a  candidate for transfer 
to neurosurgical center? (in that time of the day,  an ambulace could take 
him to a neurosurgical center in ~10-15  min)

He's still awake at this point? and arguing about being moved for further  
treatment?

My next step would be to get a CT scan of his head to document presence,  
location and amount of a bleed. Differential diagnosis currently includes  
epidural hematoma (more doubtful now that the pain is localized to the occiput),  
subdural hematoma, intra parenchymal bleed, and concussion, either simple  
(direct) or potentially complex (coup/counter coup).

I've generally found that if the CT scan shows bleeding, most folks are  more 
amenable to being transferred to specialty care, as it's easier to make  them 
understand the potential disabilities.

ck
Charles S. Krin, DO FAAFP

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Transfer to neurosurgical center