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The reason that you wanted to get a CT scan was because of the possibility of intracranial bleed. There is good evidence that the time to removal of the clot is a key determinant of survival. One study showed >85% survival if clot removed within 2 hours of injury and <20% if more than 6hours ( I will look out the references). Hence if you suspect a clot (i.e you want a CT) best to do it the way that ensures the clot is out of the head and in the bucket as quickly as possible. Well done! Matthew Dr Matthew Cooke Senior Lecturer in Emergency Care Emergency Medicine Research Group www.emerg-uk.com Primary Care Unit, Univ of Warwick Tel 01203 573005 Fax: 0870 055 8087 -----Original Message----- From: David Gunn <[log in to unmask]> To: [log in to unmask] <[log in to unmask]> Date: 04 September 1999 15:01 Subject: Re: HI child - a little help from my friends >Sounds like you were on the spot and did what you thought what was best for >the child. This takes courage and conviction. If there was a subdural or >epidural bleed he would probably have been further delayed at the DGH. >Would they have been able to cope with this? > >-----Original Message----- >From: Jel Coward <[log in to unmask]> >To: [log in to unmask] <[log in to unmask]> >Date: 03 September 1999 20:53 >Subject: HI child - a little help from my friends > > >>Hi All >> >>I have had a little 'partner' trouble recently (no not the recurrence of >>that rash ;-) >> >>I had a lad brought in (cottage hospital) - 8 yoa, 12ft (confirmed) fall >>onto concrete - initial LOC - I won't go into detail except to say that >>when I saw him he was inconsolable and not making much sense - then he >>became quiet with GCS 12-13 (E-3 (with repeated and loud voice - then >>would re-close and be difficult to rouse again), V-4, M-5) - this was >>fluctuating somewhat. His Left pupil dilated but responsive to light >>(and local bruising and I think was traumatic aetiology) >> >>He was haemodynamically stable with no signs of other injury except >>slight swelling R wrist. >> >> >>The decision is ?50 minutes to DGH with scanner but no neurosurgery/paed >>surg/paed ITU - and a v long trip from here to further care >> >>or fly - 30 mins airtime but delay in getting aircraft to site etc - >>total time to hosp likely to be doubled c.f. DGH >> >>I spoke to the consultant surgeon at the DGH - long chat - felt probably >>better to go elsewhere - this was my initial feeling and I guess I may >>have pushed him this way a little >> >>My decision was to fly to centre with facilities - and this was in the >>event.....uneventful. I accompanied the child and spent 2.5 hours in a >>taxi coming back (22:00 by this time). Aircraft was large, stable - >>with coffee machine! and full monitoring and extended trained aircrew. >> >>The major bit of this trauma has been my partner's (GP not bed) >>reaction. He was v v displeased (although I managed to get my >>receptionist make the 14 'sick' folk waiting to see me 'disappear' (to >>slots with me starting work early for the next 2 days) - and all my >>partner had to do was to cover the on-call until I returned (with me >>volunteering to do the whole following night (his) in return for the few >>hours cover for me. >> >>He seems to think it was unnecessary to make this trip - and quite >>frankly I am quite upset about it. I disagree with him but am >>infuriated by my unpreparedness to quote the evidence at him. I am now >>on my 3rd night on call and am convinced that someone has switched off >>the light at the end of the tunnel - so can anyone point me towards the >>stuff I need to read and quote.......or does anyone support my partners >>view and can provide me with info to stop me needing to 'create' this >>problem in the future? >> >> >>Many thanks all ;) >> >>Cheers >> >>PS (it is all made worse because our asst GP flew a 2 month old out just >>a few weeks ago - had HI and was unresponsive for 20 mins - partner also >>felt that this was the wrong thing to do) >>-- >>Jel Coward >> >>..take a look at the Wilderness Emergency Medicine and Command Physician >courses >> >>http://www.wildmedic.org >> >>[log in to unmask] >> >>'There's no such thing as bad weather - just bad clothing" >> Anon Norwegia >> > %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%