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Thu Mar 26 10:52:23 GMT 2009

Looks like we really ARE on the same page, eh?

Take care,
Ron

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Sanjay Gupta
Sent: Wednesday, March 25, 2009 5:51 PM
To: Trauma & Critical Care mailing list
Subject: RE: Prevetable death? from a Qc MD

Ron

I also fully agree that a trauma / acute care surgeon should be able to drain an extra-dural hematoma, and personally I have been a neurosurgery resident for close to an year and know that draining an extra-dural hematoma ain't brain surgery, but I will still always consider practicalities first and heroism later.  I do not have a veil of a University protecting me and would be very careful venturing so far away from my core competence.  And thank God - I have 2 neurosurgeons working with me, whom I religiously buy coffee twice a month.

Don't get me wrong. - If I do have a patient with an extradural hematoma and no neurosurgeon, I will drain it with a craniotomy and HELL with the lawyers.

Sanjay Gupta

--- On Wed, 3/25/09, Gross, Ronald <Ronald.Gross at baystatehealth.org> wrote:

> From: Gross, Ronald <Ronald.Gross at baystatehealth.org>
> Subject: RE: Prevetable death? from a Qc MD
> To: "'Trauma & Critical Care mailing list'" <trauma-list at trauma.org>
> Date: Wednesday, March 25, 2009, 1:41 PM
> Originally sent on 3/24, but my new
> e-mail address wasn't recognized...........
>
> Sanjay, this is my feeling about this thread.  Just in
> case you hadn't figured it out as yet!  :-)
>
> -----Original Message-----
> From: Gross, Ronald
> Sent: Tuesday, March 24, 2009 3:58 PM
> To: 'Trauma &amp; Critical Care mailing list'
> Subject: RE: Prevetable death? from a Qc MD
>
> "The surgery is not complex"
> In other words, "It ain't brain surgery!"  Sorry, but
> I couldn't resist!
>
> Truth be told, it is something that any good trauma
> surgeon, or in the new parlance, "acute care surgeon", or
> from my viewpoint, "military surgeon" could and should be
> able do.  Simple, life saving and essential.
>
> Just my 2 cents,
> Ron
>
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org]
> On Behalf Of Ben Addleman
> Sent: Tuesday, March 24, 2009 10:12 AM
> To: Trauma &amp, Critical Care mailing list
> Subject: Re: Prevetable death? from a Qc MD
>
> Never done it, never seen it done, but large areas of
> Canada (no,
> Mont-Temblant would probably not be one of them) would be
> candidates for
> non-neurosurgeon brain surgery in emergencies. I do recall
> asking some of
> the general surgeons I worked with as a family medicine
> resident (nearest
> neurosurgeon probably almost an hour away-by fixed-wing air
> transport) who
> said they'd talked rural GPs through the procedure over the
> phone a few
> times.
> >From the Canadian Journal of Rural Medicine:
> http://www.cma.ca/index.cfm/ci_id/37275/la_id/1.htm
> (first thing listed as "equipment needed" is "a sense of
> historical
> proportion."
>
>
>
> On Tue, Mar 24, 2009 at 12:46 AM, Matt Oliver <moliverzw at gmail.com>
> wrote:
>
> > There is no reason why a general surgeon should not be
> able to deal with an
> > extradural haemorrhage. Here in Australia there is a
> workshop run by a
> > neurosurgeon from Brisbane on how to do it. There are
> many hospitals in
> > remote areas where this skill is required from time to
> time. The surgery is
> > not complex.
> >
> > Matt Oliver
> > Bendigo
> > Australia
> >
> >
> > -----Original Message-----
> > From: trauma-list-bounces at trauma.org
> [mailto:
> > trauma-list-bounces at trauma.org]
> > On Behalf Of Charles Brault
> > Sent: Tuesday, 24 March 2009 7:19 AM
> > To: Trauma &amp; Critical Care mailing list
> > Subject: Re: Prevetable death? from a Qc MD
> >
> >
> >
> >
> >
> >
> > ----- Original Message ----
> > From: "Joe Nemeth, Mr" <joe.nemeth at mcgill.ca>
> > To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>;
> > "Trauma
> > & Critical Care mailing list" <trauma-list at trauma.org>
> > Sent: Sunday, March 22, 2009 9:28:16 PM
> > Subject: RE: Prevetable death? from a Qc MD
> >
> >
> > Agree with Pret's summary: the only surgeon who
> could've made a difference
> > would have been a Neurosurgeon...
> >
> >
> > **************************
> >
> >
> > 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
> > --
> > trauma-list : TRAUMA.ORG
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> >
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> >
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