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Tue May 26 15:17:53 BST 2009

Whoa.

(I have hit rock bottom, and shall commence to dig.)

Your trauma system indeed differs from mine.  But even admitting my
ethnocentrism, I must say that your trauma system seems -- well, screwy.

Severe brain injuries are delayed (or refused?) by your trauma centers
-- because of your neurosurgeons?  CAT scans are compelled, at remote
hospitals with no (or, at best, amateur) neurosurgical resources, on
severely-injured patients -- expressly for the benefit of your
neurosurgeons?  

Eek.  And your trauma surgeons are cool with that?

Be that as it may:

Count the number of isolated, unstable and operatively accessible SDH's
in your system over any recent interval.  Now count total number of
trauma patients with altered mental status otherwise compelling trauma
center admission for the same period (any patient with clinical
potential for subdural: all the head injuries, plus the multiple traumas
with low GCS).  

I'd be shocked if the ratio was greater than 1/10.  I'm actually
thinking maybe half that.

So: for the hypothetical benefit of one patient, we're willing to
significantly delay the proper transfer of ten others?  You'll be wrong
FAR more often than you'll be right.  

Oh, yes, there will be VOMIT.

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Fiona Wallace
Sent: Tuesday, May 26, 2009 5:56 AM
To: Trauma-List [TRAUMA.ORG]
Subject: Re: Blind burr holes

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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