Dr. Beffa is an emergency physician with VEP Healthcare and medical director of the emergency department at Sutter Amador Hospital in Jackson, California.
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ACEP Now: Vol 36 – No 12 – December 2017References
- Smith SW, Clark M, Nelson J, et al. Emergency department skull trephination for epidural hematoma in patients who are awake but deteriorate rapidly. J Emerg Med. 2010;39(3):377-383.
- Goodrich JT, Flamm ES. Historical overview of neurosurgery. In: Winn HR, ed. Youmans and Winn Neurological Surgery. 7th ed. Philadelphia: Elsevier; 2017:1, 8-48.
- Poon WS, Li AK. Comparison of management outcome of primary and secondary referred patients with traumatic extradural hematoma in a neurosurgical unit. Injury. 1991;22(4):323-325.
- Nelson JA. Local skull trephination before transfer is associated with favorable outcomes in cerebral herniation from epidural hematoma. Acad Emerg Med. 2011;18(1):78-85.
- Cohen JE, Montero A, Israel ZH. Prognosis and clinical relevance of anisocoria-craniotomy latency for epidural hematoma in comatose patients. J Trauma. 1996;41(1):120-122.
- Bullock MR, Chesnut R, Ghajar J, et al. Surgical management of acute epidural hematomas. Neurosurgery. 2006;58 (3 Suppl):S7-15.
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9 Responses to “How To Perform an Emergency Burr Hole Procedure”
December 28, 2017
Alexander KheradiWhat brand kit did you order for your department? Great article.
January 3, 2018
James NelsonHi Dr. Beffa,
Thank you for publishing this, as well as citing my review. We have learned a few practical things at our institution that I would like to share:
1) We find it easier, when encountered a clot that wont extrude, to irrigate gently with sterile saline. With patience, the clot will come out.
2) When you break the inner table of the skull with the Galt trephine, it is subtle. Check often for the bone fragment in the instrument.
3) Sometimes the bone fragment has broken free but does not pick up with the instrument. Probe the “disc” of bone and if loose, pick it up with Kelly forceps.
4) Don’t give up on a patient. My partner drilled on an elderly man comatose with herniating SDH. I thought he had no chance of survival, let alone recovery. He walked out of the hospital a month later.
5) Order a second Galt trephine.
Sounds like you are off to a great start as a medical director. That two year old will not be the only person you save thanks to your proactive work!
December 9, 2020
PradeepWow! It’s sounds just like one of those scenes from those medical dramas. I always wanna test my skills under pressure but at the same time i hope those situations doesn’t occurs to me. Kudos to you sir for keeping your cool and thanks for sharing your experiences
January 4, 2018
Nilantha LenoraGreat article, thanks for sharing.
If it’s all you have, would an EZ IO substitute for a Galt trephine? Would technique differ in any way?
January 15, 2018
Ira WoodFigure 1 apppeaes to be dangerously misleading. It could easily lead one to think that you set the depth stop on the drill by holding it up the CT image on your computer screen. Sure, if we stop and think about it, we all know that the CT images on our screen are not life-size, but I worry that, in the midst of a very stressful scenario, first thing someone will recall about this article is that image. There should be a reminder to use the software features to measure the thickness of the skull, and not try direct comparison, as shown in the image.
I have admit that this image pulled me in to read the article. I saw it and wondered how you were using the image to set the depth.
I realize that this sounds like common sense, but common sense is not as common as we’d like to think!
IW
January 15, 2018
Jeff LeinenGreat artical, great care, great Doctor
Thanks
January 16, 2018
Darrell Looney, MDI think the caliber of the EZ IO would be too small to allow removal of the clot, no?
September 6, 2019
Con DavUsing an IO device to make a circle of small holes and connect them has been described.
February 12, 2024
Charles Monday, Jr., M D FACS, retiredGS practice, rural, 70 mi N of Houston, Tx. Advised by lecturing neurosurgeon to NOT do burr hole for fear of lawsuit with this condition(having less than 10% chance of survival) based on pupil, etc. before we had C T Scanner.) Now we do, of course. However now, with handy helicopter service, the patient might reasonably burr holed by neurosurgeon within 90 minutes.
What to do?