The general surgeon and the head

• Previous message: The general surgeon and the head
• Next message: The general surgeon and the head
• Messages sorted by: [ date ] [ thread ] [ subject ] [ author ]

When I was in general surgery residency several years ago, we were taught
how how to diagnose and manage traumatic injuries to the head. Burr holing,
as well as craniectomies, were given to us by the senior neurosurgery fellow
(sometimes VP shunt operations, too).

In the old days, we used to perform carotid angiograms too.

Jose Luis J. Danguilan, MD
Manila, Philippines

On Thu, Mar 26, 2009 at 2:48 AM, Christos Giannou <x.giannou at gmail.com>wrote:

> 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
> --
> trauma-list : TRAUMA.ORG
> To change your settings or unsubscribe visit:
> http://www.trauma.org/index.php?/community/
>

• Previous message: The general surgeon and the head
• Next message: The general surgeon and the head
• Messages sorted by: [ date ] [ thread ] [ subject ] [ author ]