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Thu Nov 9 22:59:35 GMT 2006

Not what I call a save in any shape or form.  So that brings me to the
question - why are they operating on herniated brains?  Because they
can?

A very wise man - some fellow named Frank C. Spencer, my boss and
mentor - once said, "You can teach a monkey how to operate, and probably
the chimp will do it quite well.  On the other hand, you can only teach
someone with brains to understand when NOT to operate."

As to your question, I guess the answer is yes, if your scanner is 10
years old and the guy reading the film is a PG-1...............

>>> "oded private" <tangentcarrot at hotmail.com> 11/9/2006 9:51 AM >>>

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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Transfer to neurosurgical center