The general surgeon and the head

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The general surgeon and the head

Can we separate out the surgery from the logistics and the lawyers.

I was taught (old British school of surgery, Bailey and Love) that the
general surgeon should be able to diagnose an extra- or subdural haematoma
and perform a burr hole trepanation in extremis and under local anaesthesai
with i.v. diazepam or pentothal if necessary. (Intracerebral haematoma is a
different beast, requiring the neurosurgeon. In the wilderness, without
possibility of evacuation, the patient is dead.) Intubate and bag the
patient according to condition.

The wilderness: if you can consult with a neurosurgeon over the phone or
radio, so much the better (Australian outback scenario and probably the
great white north of Canada as well). Anecdote: the ICRC had a general
surgeon in Jenin in the West Bank during the second intifada and the
incursion of Israeli troops in the city back in 2002. He was in one hospital
and the general surgeon in a second hospital had a patient with a
penetrating brain wound. The ICRC surgeon -- for whom this was a normal
often-seen case -- walked the Palestinian surgeon through a brain
debridement over a VHF radio.

Lawyers (a particular and peculiar American problem, although it is now in
the process of being globalised): How far does one go to "save life in
extremis"?  After consultation with a specialist? When you are in the
"wilderness" of Montana or South Dakota etc. and there is a raging snow
storm and no one can fly and the ambulance is stuck in a snow drift?
Case-by-case basis? And I'll leave it to the American colleagues to discuss
and dissect this one.

For most general surgeons in the "bush" of rural Africa, Asia or Latin
America, I believe that lawyers are not much of a problem and that a
well-placed burr hole is as valuable an expertise as a C-section, although
the latter is required far more often.

cheers
-- 
christos giannou
Monemvasia Lakonia
23070 Greece
tel & fax: (++30) 27320-61772
mob: (++30) 69 74 83 28 18

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