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Tue May 26 14:27:10 BST 2009

No, truly blind, most recently in Burundi just after the war when we couldn't even get a plain x ray. 

Didn't realise the Australian case was post-scan and thought the general flavour of the posts suggested that all you need in a remote environment is a Black and Decker, a doctor with a bit of backbone and a non litiginous environment and all will be well. Clearly not! My misunderstanding.

It can be very difficult to find the clot without a scan and I hope I never have to do it again.

Miranda Voss
Worcester, South Africa. 

The Australian story was post-CT demonstrating an extra-axial
collection.....are your cases truly blind or post CT? - 

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Miranda Voss
Sent: Monday, 25 May 2009 9:00 p.m.
To: trauma-list at trauma.org
Subject: Blind burr holes

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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Blind burr holes