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Tue May 26 23:00:12 BST 2009

That actually sounds a lot like Maine except for the part about only one
helicopter (and the obvious difference that Maine is not an island).

On Tue, May 26, 2009 at 5:29 PM, julie miller <jamiller444 at yahoo.com> wrote:

> It's not screwy at all, Pret.
> Fiona has said there is only one air retrieval team in Tasmania: a sparsely
> populated island of mostly wilderness.
>
>
>
>
>
> ________________________________
> From: "Bjorn, Pret" <pbjorn at emh.org>
> To: Trauma-List [TRAUMA.ORG] <trauma-list at trauma.org>
> Sent: Wednesday, May 27, 2009 12:17:53 AM
> Subject: RE: Blind burr holes
>
> 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
> > --
> > trauma-list : TRAUMA.ORG
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> >
> >
> >
> > ____________________________________________________________
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-- 
Stephen Richey, CRT

"It is not unreasonable that we grapple with problems....Our responsibility
is to do what we can, learn what we can, improve the solutions, and pass
them on."- Richard Feynman

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