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Tue May 26 10:55:52 BST 2009

Pret,

This may be true for the area in which you work, and of course systems  
should be fitted to the individual region.

Where I work I cannot activate the retrieval system until the  
neurosurgeons have accepted the patient, and they won't do that  
without a scan. Not unreasonably, they want to distinguish between a  
patient requiring surgery and a patient with (for example) DBI, as do  
the retrieval team because it allows them to triage the urgency (we  
have only one transfer team for the entire state of Tasmania).

  A patient with a bleed is time-critical; one without may be triaged  
lower than a multitude of other diagnoses. Now maybe you're awash in  
choppers and paramedics - if so, I envy your rural hospitals because  
the decision making over here can be a bitch.

We cut our cloth...

Fiona.

On 26/05/2009, at 7:32 PM, Pret Bjorn wrote:

> ... and so we are inclined to move patients not to trauma centers, but
> rather to the nearest CT scanners.  (There was a day when it  
> amounted to the
> same thing, but hardly now.)
>
> Occasionally this will save a life; but much of the time it will delay
> proper care.
>
> Pret
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org 
> ]
> On Behalf Of Jarek
> Sent: Tuesday, May 26, 2009 12:30 AM
> To: Trauma-List [TRAUMA.ORG]
> Subject: Re: Blind burr holes
>
> No, not only one. At the beginning of my career I had few as well-  
> truly
> blind, no CT, just localizing signs, some of them turned out to be  
> oedema .
>
> Jarek
> 2009/5/25 Miranda Voss <mvossak at yahoo.co.uk>
>
>>
>> Re: Congratulations to Australian Doctor
>>
>> I also read this case with great admiration for the doctor, the  
>> system and
>> the outcome. However, I would like to give another perspective on  
>> blind
> burr
>> holes.
>>
>> I have had to do it a handful of times when in the bush with no
> possibility
>> of referral/advice (NOT South Africa) and I think it is a HORRIBLE
>> operation. I have only done it with documented decrease in  
>> consciousness
> and
>> localising signs, but I have never found a nice hematoma that could  
>> be
>> evacuated with good results; either high pressure brain has come  
>> pouring
> out
>> of the burr hole, or occasionally there has been bleeding that I  
>> have not
>> been able to stop satisfactorily. It has always left me feeling far  
>> from
>> warm and fuzzy and to be honest, I am now very reluctant to do it.
>>
>> Am I the only general surgeon/occasional skull trephiner who has  
>> never had
>> a patient waking up on the end of the drill?
>>
>> Miranda Voss
>> Worcester, South Africa
>>
>>
>> From: "ramalinga reddy" <drarumalla at yahoo.com>
>> To: trauma-list at trauma.org
>> Congrats to Rob Carson for saving the chaild
>> Many times doctors are afraid to do such thing for fear of legal
>> implications
>> It is the medical faculty which should educate the general public  
>> so that
>> litigations are minimised and doctors do such things confidently
>> Hats off to Dr RobCarson
>>
>>
>> Dr.A.R.Reddy
>> SKS Neuro Hospitals
>> Mobile: 9849018017
>>
>> --- On Fri, 22/5/09, trauma-list-request at trauma.org <
>> trauma-list-request at trauma.org> wrote:
>>
>>
>>
>>
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>>
>
>
>
> -- 
> _______________________
> Jarek Gucwa
>
> jarekgucwa at gmail.com
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Blind burr holes