Prevetable death? from a Qc MD

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First, thank you for the vocab refresher.  Chirurgery.  Ah, Latin.

Let's consider: cranial decompression in the hands of a general surgeon or EM clinician will always be a striking departure from optimal practice, and thus reserved for extreme emergencies.  By definition, these cases will be ABSOLUTELY NO FUN WHATSOEVER -- high risk, problem-prone, exceedingly rare, and exposed to all manner of post hoc faultfinding unless the outcome is miraculous.  Be assured, the first f**k-up (somewhere in the first five cases worldwide) would make international news and leave us all to regret that we ever thought of such a boneheaded stunt.

(Honestly, that just came out.  No pun intended.)

Admit too that we're talking about extremely rural and isolated cases falling in the laps of extremely rural and isolated doctors.  The career-to-craniotomy ratio would certainly fall well shy of 1:10.  By the time the trained clinician recognizes the indication, determines the intervention, assembles his resources and summons up his courage, ninety per cent of these cases would probably be better off en route to the trauma center, by almost any means faster than foot.

Setting aside that any reasonable training for this procedure is bound to be expensive -- if even feasible -- how would the process ever be safely systematized and implemented?  And at what cost, when many hospitals can't even afford send docs to ATLS?

Sorry, but except maybe in Alaska or Australia, I'm not seeing any good coming of this.

SEE ALSO trauma c-section; open-chest CPR.

Just me, just now.

Pret Bjorn, RN
Bangor, ME

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Charles Brault
Sent: Monday, March 23, 2009 4:19 PM
To: Trauma & Critical Care mailing list
Subject: Re: Prevetable death? from a Qc MD

 
The question is left suspended...
 
Should general surgeons (emergency Physicians) be credentialed to do emergency cranial decompressions?
Should there be a basic consensus as to the point where a "field" (outlying hospital) neurochir. Intervention
Should there be a credentialing system put in place (Advanced Neuro-Chirurgical Rescue certification)
 
If not
Why not ?
 
 
Charles
While you are twisting their arm
Slap them a good one across the head and tell them to stop doing neonatal transports
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