List Archives

Sun Nov 5 13:18:06 GMT 2006

The patient did not refuse a move to a neurosurgical center, since they 
didn't offer it, at least until I was already gone. I'm asking whether the 
move should have been a primary consideration by the FIRST physician who 
attended him.

>From: Krin135 at aol.com
>Reply-To: "Trauma &amp; Critical Care mailing list" 
><trauma-list at trauma.org>
>To: trauma-list at trauma.org
>Subject: Re: Transfer to neurosurgical center
>Date: Sat, 4 Nov 2006 16:20:52 EST
>
>
>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