In a message dated 6/24/2003 3:55:26 AM Eastern Daylight Time, [log in to unmask] writes:
Certainly one option. Burr hole may be life saving. On the other hand it may
delay definitive neurosurgical treatment and may be fatal in itself (how
confident are you that you can deal with a major bleed from the meningeal
vessels. A bit of a judgement call.
I agree it is a judgment call and I don't mind that we disagree. I do suspect she is coning and has very little time and little chance of survival. In this case the injury occurred last night as I recall and she may very well have clot in much of the epidural and may be difficult to drain. The fact that her condition is worsening suggests to me that she is having continued bleeding.
I think the approach in an emergency department is going to be different from that in the OR. The site of blood accumulation has been localized to the temporal region. I think I would only do one burr hole. It is a last ditch effort as it is. And yes I would risk her having major bleeding at this point. I really think this patient is displaying preterminal clinical signs.
I have never had to do one myself, but have known two physicians that have with good result.
Renee
