Burr hole - Revision history

Blsimpso at 01:18, 29 June 2021

2021-06-29T01:18:52Z

← Older revision		Revision as of 01:18, 29 June 2021
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	*[[Epidural hemorrhage]]		*[[Epidural hemorrhage]]
	*[[Subdural hemorrhage]]		*[[Subdural hemorrhage]]

			==External Links==

			===Videos===
			{{#widget:YouTube\|id=QeDQZoeg0RA}}

	==References==		==References==

Rossdonaldson1: /* Disposition */

2019-05-17T06:29:39Z

Disposition

← Older revision		Revision as of 06:29, 17 May 2019
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	==Disposition==		==Disposition==
	*Provide ceftriaxone IV for antibiotic prophylaxis after procedure		*Provide [[ceftriaxone]] IV for antibiotic prophylaxis after procedure
	*Transfer immediately to facility with appropriate ICU and neurosurgical capability		*Transfer immediately to facility with appropriate ICU and neurosurgical capability

SLuckettG: /* Follow-up */

2019-05-08T18:40:38Z

Follow-up

← Older revision		Revision as of 18:40, 8 May 2019
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	*Once blood flow slows/stops, apply loose dressing (DO NOT tamponade bleeding)		*Once blood flow slows/stops, apply loose dressing (DO NOT tamponade bleeding)

	==~~Follow-up~~==		==Disposition==
	*~~After~~ procedure~~, patient should be~~ immediately ~~transferred~~ to facility with appropriate neurosurgical ~~availability.~~		*Provide ceftriaxone IV for antibiotic prophylaxis after procedure
			*Transfer immediately to facility with appropriate ICU and neurosurgical capability

	==Complications==		==Complications==

SLuckettG: /* ProcedureMacLellan, K. The occasional burr hole. CJRM 1998;3(4):223-2 */

2019-05-08T18:39:45Z

ProcedureMacLellan, K. The occasional burr hole. CJRM 1998;3(4):223-2

Mholtz at 02:15, 5 September 2016

2016-09-05T02:15:14Z

← Older revision		Revision as of 02:15, 5 September 2016
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	==Procedure<ref name="Wilson" /><ref>MacLellan, K. The occasional burr hole. CJRM 1998;3(4):223-2</ref>==		==Procedure<ref name="Wilson" /><ref>MacLellan, K. The occasional burr hole. CJRM 1998;3(4):223-2</ref>==
			[[File:burr hole.JPG\|thumb]]

	*Place patient supine		*Place patient supine
	*Select optimal site based on location of hemorrhage on CT (if unsure, use temporal site)		*Select optimal site based on location of hemorrhage on CT (if unsure, use temporal site)
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	*Allow blood to drain freely (gentle suction may be used, but DO NOT suction brain tissue)		*Allow blood to drain freely (gentle suction may be used, but DO NOT suction brain tissue)
	*Once blood flow slows/stops, apply loose dressing. (DO NOT tamponade bleeding)		*Once blood flow slows/stops, apply loose dressing. (DO NOT tamponade bleeding)
	~~[[File:burr hole.JPG\|thumbnail]]~~

	==Follow-up==		==Follow-up==

Neil.m.young: Text replacement - " pt " to " patient "

2016-07-02T05:00:05Z

Text replacement - " pt " to " patient "

← Older revision		Revision as of 05:00, 2 July 2016
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	*Lack of imaging-confirmed epidural or subdural hematoma		*Lack of imaging-confirmed epidural or subdural hematoma
	**In absence of imaging (e.g. in rural/wilderness area at facility without CT availability), very high clinical suspicion may be enough.<ref name="Wilson" />		**In absence of imaging (e.g. in rural/wilderness area at facility without CT availability), very high clinical suspicion may be enough.<ref name="Wilson" />
	***e.g. evidence of severe head trauma and unequal pupils, pt presents awake and talking but rapidly deteriorates in setting of head trauma and unequal pupils, etc.		***e.g. evidence of severe head trauma and unequal pupils, patient presents awake and talking but rapidly deteriorates in setting of head trauma and unequal pupils, etc.

	==Considerations<ref>Hacking C and Elgendy A. Uncal herniation. Radiopaedia. http://radiopaedia.org/articles/uncal-herniation-1.</ref>==		==Considerations<ref>Hacking C and Elgendy A. Uncal herniation. Radiopaedia. http://radiopaedia.org/articles/uncal-herniation-1.</ref>==
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	==Follow-up==		==Follow-up==
	*After procedure, pt should be immediately transferred to facility with appropriate neurosurgical availability.		*After procedure, patient should be immediately transferred to facility with appropriate neurosurgical availability.

	==Complications==		==Complications==

Ostermayer: Text replacement - "Category:Neuro" to "Category:Neurology"

2016-03-22T14:14:40Z

Text replacement - "Category:Neuro" to "Category:Neurology"

← Older revision		Revision as of 14:14, 22 March 2016
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	[[Category:Procedures]]		[[Category:Procedures]]
	[[Category:Critical Care]]		[[Category:Critical Care]]
	[[Category:~~Neuro~~]]		[[Category:Neurology]]

Kxl328 at 03:52, 16 February 2016

2016-02-16T03:52:56Z

← Older revision		Revision as of 03:52, 16 February 2016
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	**In absence of imaging (e.g. in rural/wilderness area at facility without CT availability), very high clinical suspicion may be enough.<ref name="Wilson" />		**In absence of imaging (e.g. in rural/wilderness area at facility without CT availability), very high clinical suspicion may be enough.<ref name="Wilson" />
	***e.g. evidence of severe head trauma and unequal pupils, pt presents awake and talking but rapidly deteriorates in setting of head trauma and unequal pupils, etc.		***e.g. evidence of severe head trauma and unequal pupils, pt presents awake and talking but rapidly deteriorates in setting of head trauma and unequal pupils, etc.

			==Considerations<ref>Hacking C and Elgendy A. Uncal herniation. Radiopaedia. http://radiopaedia.org/articles/uncal-herniation-1.</ref>==
			*Unilateral transtentorial herniation (more common) usually causes ipsilateral fixed and dilated pupil if it localizes
			*Bilateral transtentorial herniation (less common) due to extensive mass effect or severe trauma

	==Equipment Needed==		==Equipment Needed==

Kxl328: /* ProcedureMacLellan, K. The occasional burr hole. CJRM 1998;3(4):223-2 */

2015-12-30T01:43:15Z

ProcedureMacLellan, K. The occasional burr hole. CJRM 1998;3(4):223-2

← Older revision		Revision as of 01:43, 30 December 2015
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	*Allow blood to drain freely (gentle suction may be used, but DO NOT suction brain tissue)		*Allow blood to drain freely (gentle suction may be used, but DO NOT suction brain tissue)
	*Once blood flow slows/stops, apply loose dressing. (DO NOT tamponade bleeding)		*Once blood flow slows/stops, apply loose dressing. (DO NOT tamponade bleeding)
			[[File:burr hole.JPG\|thumbnail]]

	==Follow-up==		==Follow-up==

Mholtz at 02:33, 18 August 2015

2015-08-18T02:33:35Z

← Older revision		Revision as of 02:33, 18 August 2015
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	**'''Frontal''' - 10 cm above eye in mid-pupillary line		**'''Frontal''' - 10 cm above eye in mid-pupillary line
	*Shave scalp widely over selected site		*Shave scalp widely over selected site
	*Cleanse skin with chlorhexidine or betadine		*Cleanse skin with chlorhexidine or betadine and drape in sterile fashion
	*Make ~3cm incision and dissect down to bone with scalpel		*Make ~3cm incision and dissect down to bone with scalpel (control bleeding with direct pressure or electrocautery)
	*Dissect periosteum off bone with scalpel		*Dissect periosteum off bone with scalpel
	*Apply retractors to maintain field		*Apply retractors to maintain field
	*Apply drill perpendicular to skull and begin drilling while applying firm pressure		*Apply drill perpendicular to skull and begin drilling while applying firm pressure
	**Have assistant apply gentle saline wash to drilling site		**Have assistant apply gentle saline wash to drilling site
	*Continue drilling until loss of resistance felt '''or''' drill bit stops spinning (~~assuming use of~~ "clutch"-type drill bit)		*Continue drilling until loss of resistance felt '''or''' drill bit stops spinning (when using "clutch"-type drill bit)
	*Use hooks to remove any remaining bone fragments		*Use hooks to remove any remaining bone fragments
	*If subdural hematoma, elevate dura with sharp hook and make careful incision with scalpel		*If subdural hematoma, elevate dura with sharp hook and make careful incision with scalpel

← Older revision		Revision as of 18:39, 8 May 2019
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	**'''Temporal''' - 2 finger-breadths above and 2 finger-breadths forward of the auditory canal		**'''Temporal''' - 2 finger-breadths above and 2 finger-breadths forward of the auditory canal
	**'''Parietal''' - over parietal eminence		**'''Parietal''' - over parietal eminence
	**'''Frontal''' - 10 cm above eye in mid-pupillary line		**'''Frontal''' - 10 cm above eye in mid-pupillary line (about 3 cm from sagittal suture)
	*Shave scalp widely over selected site		*Shave scalp widely over selected site
	*Cleanse skin with ~~chlorhexidine~~ or betadine and drape in sterile fashion		*Cleanse skin with chlorhexadine or betadine and drape in sterile fashion
			*Set drill depth based on thickness of skull (as measured on CT)
	*Make ~3cm incision and dissect down to bone with scalpel (control bleeding with direct pressure or electrocautery)		*Make ~3cm incision and dissect down to bone with scalpel (control bleeding with direct pressure or electrocautery)
	*Dissect periosteum off bone with scalpel		*Dissect periosteum off bone with scalpel
Line 50:		Line 51:
	*Continue drilling until loss of resistance felt '''or''' drill bit stops spinning (when using "clutch"-type drill bit)		*Continue drilling until loss of resistance felt '''or''' drill bit stops spinning (when using "clutch"-type drill bit)
	*Use hooks to remove any remaining bone fragments		*Use hooks to remove any remaining bone fragments
			**Preserve skull fragments in container of sterile saline
	*If subdural hematoma, elevate dura with sharp hook and make careful incision with scalpel		*If subdural hematoma, elevate dura with sharp hook and make careful incision with scalpel
	*Allow blood to drain freely (gentle suction may be used, but DO NOT suction brain tissue)		*Allow blood to drain freely (gentle suction may be used, but DO NOT suction brain tissue)
	*Once blood flow slows/stops, apply loose dressing. (DO NOT tamponade bleeding)		*Once blood flow slows/stops, apply loose dressing (DO NOT tamponade bleeding)

	==Follow-up==		==Follow-up==