List Archives

Wed Nov 8 00:51:16 GMT 2006

"Saying- the decision that a pateint is not a neurosurgical pt. is a
decision made by neurosurgeons, isn't it?"..........

Not with a normal CT scan it isn't.  If the proximity of the tertiary
hospitals isn't an issue, you certainly could transfer the patient.  And
if the issue weren't a neurosurgical one, then you have just spend a
whole of time, effort, and money for  a patient that could have very
safely been watched at the community (non-neurosurgical) hospital.  
One last thought - if the patient does herniate, then he won't need an
operation.......
Take care,
Ron

>>> "oded private" <tangentcarrot at hotmail.com> 11/6/2006 2:21 PM >>>
Sounds reasonable it might be something else than neurosurgical. But if
he's 
stable, and there are THREE neurosurgical centers in proximity (which
the 
hospital must have a transfer agreement with at least one of them), why
not 
work him up there, so if he does herniate he can be operated
immidiately?( 
the first doctor did order tox. to be checked out for in pt's blood,
but 
could simply fax the result...). I'm quite sure, by the way, the trauma

centers all have better resolution CT scanner than the receiving
hospital.
AS the ATLS says, (it's not about neurosurgery, but still)- the
decision not 
to operate is a surgical decision made by surgeons. Saying- the
decision 
that a pateint is not a neurosurgical pt. is a decision made by 
neurosurgeons, isn't it?

>From: "Ronald Gross" <Rgross at harthosp.org>
>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: Mon, 06 Nov 2006 05:30:23 -0500
>
>Sounds like something more than just a neuro issue - tox related,
>perhaps?  I'd work him up before transfer if you are not convinced
that
>this is a CNS/CHI issue.
>
> >>> "oded private" <tangentcarrot at hotmail.com> 11/6/2006 3:10 AM >>>
>
>At the hospital, he had a GCS score of 15, and had short range (few
>hours)
>retrograde and antegrade amnesia (he could tell he was in a hospital,
>but
>know how he got there or what happened. He neither remebered any of
the
>
>events in the few hours before the incident). He was sleepy,
shievering
>and
>cold (it wasn't very cold there), and kept complaining about
weakness.
>At the scene it was just the same, since he woke up the first time.
He
>was
>vomiting a lot and too weak to stand up.
>
> >From: "Ronald Gross" <rgross at harthosp.org>
> >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: Sun, 05 Nov 2006 14:03:36 -0500
> >
> >OK - you need to give us more.  What was the kid's GCS at the
>hospital?
> >Was he awake at the scene - I mean awake and alert other than the
> >amnesia?  That will help determine if transfer is appropriate.
> >
> > >>> "oded private" <tangentcarrot at hotmail.com> 11/04/06 2:12 PM
>>>
> >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)
> >
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Transfer to neurosurgical center