{"id":9842,"date":"2014-09-24T11:41:03","date_gmt":"2014-09-24T15:41:03","guid":{"rendered":"https:\/\/crashingpatient.com\/?p=9842"},"modified":"2014-09-24T14:50:25","modified_gmt":"2014-09-24T18:50:25","slug":"burr-holes-skull-trephination","status":"publish","type":"post","link":"https:\/\/crashingpatient.com\/procedures\/burr-holes-skull-trephination.htm\/","title":{"rendered":"Burr Holes and Skull Trephination"},"content":{"rendered":"

UC Davis Cheat Sheet<\/a><\/p>\n

Acad Emerg Med 2011;18:78<\/p>\n

 <\/p>\n

Emergency department skull trephination for epidural hematoma in patients who are awake but deteriorate rapidly.<\/p>\n

(J Emerg Med. 2010 Sep;39(3):377-83.)<\/p>\n

Authors Smith SW, et al. Show all Journal\u00a0\u00a0 doi: 10.1016\/j.jemermed.2009.04.062. Epub 2009 Jun 17. Affiliation Comment in\u00a0\u00a0\u00a0\u00a0\u00a0 J Emerg Med. 2012 Dec;43(6):e489-90.\u00a0 Abstract\u00a0 BACKGROUND: Blunt head trauma patients who have been alert but are deteriorating (talk and deteriorate [T&D]) due to a rapidly expanding epidural hematoma (EDH) usually have poor outcome if they must wait for hospital transfer for evacuation. We therefore have continued to teach skull trephination to emergency physicians (EPs). We are unaware of any literature on EP trephination for EDH in the age of computed tomography (CT) scanning.\u00a0 METHODS: Patients with EDH from blunt trauma, either in our institution or known to our graduate network, who were T&D with anisocoria despite intubation plus medical therapy, and who had pre-transfer EP trephination, were compared to those who were transferred without trephination.\u00a0 RESULTS: There were 5 patients with blunt trauma and CT-proven EDH who were T&D with anisocoria who underwent Emergency Department (ED) trephination at outlying hospitals before transfer. All 5 had improvement in condition and good outcomes. Three had complete recovery without disability and 2 others had mild disability with good cognitive function. None had complications. Two patients with T&D and anisocoria were transferred without trephination. Both had good neurologic outcomes. The mean time to pressure relief in the trephination group vs. transfer group was 55 vs. 207 min, respectively.\u00a0 CONCLUSION: In T&D patients with CT-proven EDH and anisocoria, ED skull trephination before transfer resulted in uniformly good outcomes without complications. Time to relief of intracranial pressure was significantly shorter with trephination. Neurologic outcomes were not different.<\/p>\n","protected":false},"excerpt":{"rendered":"

UC Davis Cheat Sheet Acad Emerg Med 2011;18:78   Emergency department skull trephination for epidural hematoma in patients who are awake but deteriorate rapidly. (J Emerg Med. 2010 Sep;39(3):377-83.) Authors Smith SW, et al. Show all Journal\u00a0\u00a0 doi: 10.1016\/j.jemermed.2009.04.062. Epub 2009 Jun 17. Affiliation Comment in\u00a0\u00a0\u00a0\u00a0\u00a0 J Emerg Med. 2012 Dec;43(6):e489-90.\u00a0 Abstract\u00a0 BACKGROUND: Blunt head […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[5],"tags":[],"yoast_head":"\nBurr Holes and Skull Trephination - Crashing Patient<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/crashingpatient.com\/procedures\/burr-holes-skull-trephination.htm\/\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"CrashMaster\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"1 minute\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/crashingpatient.com\/procedures\/burr-holes-skull-trephination.htm\/\",\"url\":\"https:\/\/crashingpatient.com\/procedures\/burr-holes-skull-trephination.htm\/\",\"name\":\"Burr Holes and Skull Trephination - 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