Prevetable death? from a Qc MD

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I think everyone is missing the point here

As a trauma/ general/ former military surgeon I would do burr holes if needed in that  circumstance. Enough said about that. The point is not whether there is nursing care, or whether your going to do it in the ICU or what EMS is going to think, the point is you are only going to do it in there is clear evidence of deteriorating function and a progressive space occupying lesion and you cannot get the patient to definitive care immediately. You are not going to attempt a curative procedure unless there is no way you can get the patient out. You are going to decompress, realizing that the bleed is ongoing and continue to work to move the patient as rapidly as possible. To attempt a flap unless there is absolutely no way the patient can be gotten to definitive care is foolhardy.

Having said that we recently saw a twelve year old transferred 90 minutes with an obvious progressive space occupying EDH because the neurosurgeons" in town didn't do trauma".


R Wigle MD FACS
LSUS Trauma/ Critical Care

--- On Fri, 3/27/09, Larry Torrey <LTorrey at maine.rr.com> wrote:

> From: Larry Torrey <LTorrey at maine.rr.com>
> Subject: Re: Prevetable death? from a Qc MD
> To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
> Date: Friday, March 27, 2009, 2:22 PM
> Bjorn, Pret wrote:
> > ...How long does it take you to determine if local
> talent can drain the
> > skull if need be?  How long does it take to get a
> brain CT?  How long
> > does it take to assemble the personnel and equipment
> to safely manage
> > the craniotomy?...
> 
> Pret brings up some excellent points, but this discussion
> is missing one more topic.  The nursing care. 
> Given that this is a predominantly physician board, I guess
> that would be natural.
> 
> If you're going to drill a hole in someone's head in a
> rural or small hospital where the physician is inexperienced
> in this procedure, it follows that the nurses will be at
> least as inexperienced - probably more so.  I've worked
> in level I ERs for many years, and have never seen 
> this done in the department.  I wouldn't have a clue
> how to manage it, and certainly the trauma team won't stay
> there to feed and care for it until the ICU is ready.
> 
> So what will you do for this pt 10 minutes after the
> procedure?  The ER will want nothing to do with it,
> because they likely have neither the equipment nor expertise
> to assist or care for it.
> 
> Do it in the OR?  Ok, good, if you can manage
> it.  More time added to the equation to make that
> arrangement, to call OR staff in from home, etc. 
> Remember, we're not in a level I here.  Maybe we can do
> it quicker in the ICU?  Maybe.  Is there a bed
> available?
> 
> Great discussion about the procedure itself, but it will
> not be done in a vacuum.
> 
> LT
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