List Archives

Thu Nov 9 14:51:50 GMT 2006

Can't a normal CT br a matter of interpretation and resolution of scanner?

">One last thought - if the patient does herniate, then he won't need an
>operation......."

A few months ago I met a neurosurgeon who told me his unit did operate on 
pateints that had already herniated, and even occiasionaly saved a pateint- 
but with a very, very poor outcome.

>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: Tue, 07 Nov 2006 19:51:16 -0500
>
>"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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