Burr Holes
This is not a new concept – indeed skull trephination has been with us from Neolithic times onwards – with bone trephination used as primitive emergency surgery to remove shattered bone and blood clots typical for weapons such as slings and clubs - Tim Leeuwenburg
HWN Suggests
Cranial burr holes in the emergency department: to drill or not to drill?
Closed head injuries do not evoke the same visceral response and call to action in the ED as a dying trauma patient with a tension pneumothorax or visible massive haemorrhage. A more clandestine killer, the extra-axial haemorrhage wreaks its havoc out of sight and does not leak on the floor as it claims its victims quietly and terribly effectively.
Yet the mass effect of expanding extradural and subdural haemorrhages on the brainstem is akin to and equally as lethal as a tension pneumothorax compromising cardiac output and oxygenation.
Featured
How To Perform an Emergency Burr Hole Procedure
The medical literature supports skull trephination by emergency physicians in emergency departments without immediate neurosurgery capability for the talk-and-deteriorate patient with anisocoria, Glasgow Coma Scale (GCS) score <9, and CT-proven epidural hematoma (EDH).
Intraosseous Needle for Craniotomy
This week, I would like to present a case study by Bulstrode et al (Injury, Int. J. Care Injured 48 (2017) 1098–1100) on the use of the EZ-IO drill for drainage of an extradural haemorrhage.
Trauma Tuesday: Burr Holes!
The safest location for the ED physician is to go for the temporal site, due to lowest risk of further puncturing the middle meningeal artery. The temporal site is found by going 2 cm anterior and then 2 cm superior to the tragus...
Articles of Interest
Burr Holes in the Bush
This is not a new concept – indeed skull trephination has been with us from Neolithic times onwards – with bone trephination used as primitive emergency surgery to remove shattered bone and blood clots typical for weapons such as slings and clubs.
Burr Holes by Emergency Physicians
The authors recommend in EDH that the procedure should be done within 60–90 min of onset of anisocoria.
Cranial Burr Hole
Use CT for guidance. If no CT is available: 2 cm superior, 2 cm anterior to tragus, ipsilateral to blown pupil (temporal site). Shave the hair, prep and drape.
Cranial Burr Holes and Emergency Craniotomy: Review of Indications and Technique
Burr hole craniotomy for posttraumatic intracranial hematoma is rarely performed since the advent of computerized tomography revolutionized the treatment of these patients. It is still necessary in unique circumstances although, and the clinical urgency may require surgery by a non-neurosurgeon.
Unlocking Common ED Procedures – Crackin’ the Cranium: A Review of Cranial Burr Hole Decompression
The decision to drill through someone’s skull should not be made lightly, and so the indications for such an event must be clear.
