%0 Journal Article
%T Emergency burr holes: "How to do it"
%A Mark H Wilson
%A David Wise
%A Gareth Davies
%A David Lockey
%J Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
%D 2012
%I BioMed Central
%R 10.1186/1757-7241-20-24
%X No patients involvedThis paper describes a simple approach to emergency burr hole evacuation of extra-axial intracranial haematoma that can be used in the uncommon situation when life saving specialist neurosurgical intervention is not available.Rapidly expanding intracranial haematomas associated with fixed dilated pupils are rapidly fatal. A recently fixed dilated pupil with corresponding imaging evidence of an extra-axial haematoma is considered an indication for emergency targeted burr hole placement.Extra-axial haematomas (extradural/subdural) by definition are outside the brain and hence are not a primary brain injury. It is the delay in removing the compression of the brain by the clot that causes brain injury and death.Ideal treatment is provided by immediate specialist neurosurgical care. However in many parts of the world, this is not always available and the risks of delay associated with secondary transfer have to be balanced with the risks of the procedure being done by a non-specialist. At one UK neurosurgical centre, the median transfer time was 5.25 hours for patients with extradural haematoma and 6 hours for subdural haematoma [1]. The prolonged transfer of a patient with fixed/dilated pupils is unlikely to have a good outcome. Transfer of this type of patient is analogous to transferring a patient with other time critical but reversible pathology such as a tension pneumothorax. There are many reports of non-specialists successfully performing emergency burr holes [2]. These are often done with household drills and other makeshift tools which, when successful, has created media interest [3]. Although there have been significant technical advances in the safety of the procedure since the time of "exploratory" burr holes, there has simultaneously been a reduction in the number of surgeons either having experience in or being willing to perform the procedure. A number of general surgeons working in remote areas of Australia are more confident in perfor
%K Burr Hole
%K Extradural haematoma
%K Remote Medicine
%U http://www.sjtrem.com/content/20/1/24