Burr hole: Difference between revisions
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==Background== | |||
*Expanding intracranial hematoma is rapidly fatal and requires early therapeutic intervention. Morbidity/mortality significantly increases if treatment delayed more than 1.9 hours.<ref>Mendelow AD, Karmi MZ, Paul KS, Fuller GA, Gillingham FJ. Extradural haematoma: effect of delayed treatment. British Medical Journal. 1979;1(6173):1240-1242.</ref> | |||
==Indications== | ==Indications== | ||
*[[Epidural hemorrhage|Epidural]] or [[Subdural hemorrhage|subdural]] hematoma with midline shift on imaging and unequal pupils on exam.<ref name="Wilson">Wilson MH, Wise D, Davies G, Lockey D. Emergency burr holes: “How to do it.” Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2012;20:24. doi:10.1186/1757-7241-20-24.</ref> | |||
*GCS <8 | |||
*Anticipated extended time to assessment/treatment by neurosurgeon. | |||
==Contraindications== | ==Contraindications== | ||
*GCS >8 | |||
*Neurosurgery available in reasonable timeframe | |||
*Lack of imaging-confirmed epidural or subdural hematoma | |||
**In absence of imaging (e.g. in rural 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. | |||
==Equipment Needed== | ==Equipment Needed== | ||
*Sterile PPE | |||
*Razor | |||
*Chlorhexidine or betadine | |||
*Scalpel | |||
*Small retractors | |||
*Drill (manual or air/electric powered) | |||
**Should have both sharp (penetrator) and dull drill bits '''or''' a drill bit with appropriate "clutch" mechanism | |||
*Electrocautery (Bovie), if available | |||
==Procedure== | ==Procedure== | ||
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==See Also== | ==See Also== | ||
[[Epidural hemorrhage]] | |||
[[Subdural hemorrhage]] | |||
==External Links== | ==External Links== | ||
Revision as of 07:56, 22 July 2015
Background
- Expanding intracranial hematoma is rapidly fatal and requires early therapeutic intervention. Morbidity/mortality significantly increases if treatment delayed more than 1.9 hours.[1]
Indications
- Epidural or subdural hematoma with midline shift on imaging and unequal pupils on exam.[2]
- GCS <8
- Anticipated extended time to assessment/treatment by neurosurgeon.
Contraindications
- GCS >8
- Neurosurgery available in reasonable timeframe
- Lack of imaging-confirmed epidural or subdural hematoma
- In absence of imaging (e.g. in rural area at facility without CT availability), very high clinical suspicion may be enough.[2]
- 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.
- In absence of imaging (e.g. in rural area at facility without CT availability), very high clinical suspicion may be enough.[2]
Equipment Needed
- Sterile PPE
- Razor
- Chlorhexidine or betadine
- Scalpel
- Small retractors
- Drill (manual or air/electric powered)
- Should have both sharp (penetrator) and dull drill bits or a drill bit with appropriate "clutch" mechanism
- Electrocautery (Bovie), if available
Procedure
Complications
See Also
Epidural hemorrhage Subdural hemorrhage
External Links
References
- ↑ Mendelow AD, Karmi MZ, Paul KS, Fuller GA, Gillingham FJ. Extradural haematoma: effect of delayed treatment. British Medical Journal. 1979;1(6173):1240-1242.
- ↑ 2.0 2.1 Wilson MH, Wise D, Davies G, Lockey D. Emergency burr holes: “How to do it.” Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2012;20:24. doi:10.1186/1757-7241-20-24.