Prevetable death? from a Qc MD

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We successfully drained one in Wangaratta this week, 11yo girl with 100%
recovery, done in consultation with neuro team after teleradiology review of
CT scan and clinical discussion.

Post op immediate transfer to tertiary centre via helo (240km)

We have done 3 others in the last 2 years under similar scenario with
clinical improvement in all cases, I would not claim any cures in those
cases, but they are usually moribund adults before the non expert
intervention is contemplated, as we all know they don’t bounce quite as well
as kids.

Cheers

Greg.

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Matt Oliver
Sent: Wednesday, March 25, 2009 7:24 AM
To: 'Trauma & Critical Care mailing list'
Subject: RE: Prevetable death? from a Qc MD

Pret

Here it is always done in consultation with the neurosurgeon that the
patient will be sent to afterwards. This should ensure that it is done
appropriately and the responsibility is shared.

Matt Oliver
Bendigo
Australia

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Bjorn, Pret
Sent: Wednesday, 25 March 2009 6:43 AM
To: Trauma & Critical Care mailing list
Subject: RE: Prevetable death? from a Qc MD

Excellent, Charles; and as always, a poetic read.  But although ancient
history isn't my strong suit (I have no strong suits), I don't think the
Romans learned all that much from the French.  (No offense.  Hey, I'm
Danish.)

But I digress.

I guess I should rethink (or at least rephrase) my stance.  I'm not arguing
to do nothing; I'm merely reluctant with the premise that heroic
improvisations should be expressed as broadly necessary, articulated as
policy, or adopted into complex systems.  


I've no complaint if a skier or two in the mountains of Canada gets
trephined, outcome notwithstanding.  Just be sure that they represent the
lucky exception, not the everyday rule.  

Pret


-----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 6:21 PM
To: Trauma & Critical Care mailing list
Subject: Re: Prevetable death? from a Qc MD


First, thank you for the vocab refresher.  Chirurgery.  Ah, Latin.
*****************
Chirurgie ! Ah French ! ! ! ... rather


Otherwise
You come up with all the excellent argument to do nothing for patients that
are essentialy circling the drain
You compare the Epidural to the Emergency C-Section
I contend that epidurals probably occur 50:1 to the required (likely futile)
C-Section

I don't know 
A lot of good people (young) die from this reversible condition
Once you pretty much assume the patient is going to die
You can allow yourself
Expecially if you have access to Surgical consult or god forbid robot
surgery

I think there is room to be bold
It can not be more dangerous or more bold than citizen CPR

Note that :

 
From: Prasanna Simha M <prasannasimha at gmail.com>
To: Discussion of Critical Care Medicine <ccm-l at ccm-l.org>
Sent: Thursday, March 19, 2009 1:21:00 PM
Subject: Re: [CCM-L] Ski accident

Boils down to training and if it is non posterior fossa. When we trained we
did supratentorial hematoma's leaving the infratentorial ones to the
neurosurgeons.(And I haven't done one now for years (I can now say decades
!!) but would do a supratentorial one if required even today)
Prasanna

A N D

One has but 70 min from the onset of coma to remove them and these patients
then do so well that we don't even include isolated EDH patients in our
ongoing studies of traumatic brain injury

Bill



And General surgeons are no neophytes either


I don't know

Present state, does not add up to me


Charles
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