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The New Coffee Room

  1. TNCR
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  3. Brave Doc

Brave Doc

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  • AxtremusA Axtremus

    Enlighten me ... why is this a big deal?

    George KG Offline
    George KG Offline
    George K
    wrote on last edited by
    #3

    @Axtremus said in Brave Doc:

    Enlighten me ... why is this a big deal?

    https://pubmed.ncbi.nlm.nih.gov/36229321/

    "Now look here, you Baltic gas passer... " - Mik, 6/14/08

    The saying, "Lite is just one damn thing after another," is a gross understatement. The damn things overlap.

    1 Reply Last reply
    • AxtremusA Axtremus

      Enlighten me ... why is this a big deal?

      George KG Offline
      George KG Offline
      George K
      wrote on last edited by
      #4

      @Axtremus you have to understand that the skull is basically a closed box and there is no place for tissue to expand if there is a mass such as a tumor, swelling due to an undetermined cause, or bleeding.

      Something has to move, and the only place it can go is through the hole at the base of the skull called the for Raymond Magnum. When the base of the brain "herniate" through the base of the skull through the Foremen Magnum (which literally means "big hole."), the centers which control breathing heart rate, and even consciousness have their blood supply compromised.

      Therefore, in acute situations with brain bleeding, it is important to remove any cause of brain swelling that can compromise neural tissue.

      In this particular case, the optimal treatment would be to take the patient to the operating room make a hole in her skull, and drain the bleeding through that skull. However, in this case, there was no neurosurgeon available and so the emergency room doctor took advantage of the only tools he had to gain access to the hematoma.

      The IO 10 needle is used to administer fluid fluids through an intraosseous route. That means, if you can't get an IV started somewhere, you insert a large needle into the bone marrow, usually in the front of the shin bone, the tibia. You can then administer fluids through that in a hurry to resuscitate someone.

      In this case, the ER doc use the IO needle to the blood drain out from the hematoma, decompressing the brain. He had the assistance of a neurosurgeon via telephone to guide him where to place the needle.

      "Now look here, you Baltic gas passer... " - Mik, 6/14/08

      The saying, "Lite is just one damn thing after another," is a gross understatement. The damn things overlap.

      AxtremusA 1 Reply Last reply
      • George KG Offline
        George KG Offline
        George K
        wrote on last edited by George K
        #5

        if you look at this patient's CT scan, you can see where the epidural hematoma is with the Io needle inserted into it for draining the hematoma.
        Screenshot 2025-01-04 at 7.16.45 PM.png

        see the difference in density that I've circled? That's the hematoma.

        "Now look here, you Baltic gas passer... " - Mik, 6/14/08

        The saying, "Lite is just one damn thing after another," is a gross understatement. The damn things overlap.

        1 Reply Last reply
        • RenaudaR Offline
          RenaudaR Offline
          Renauda
          wrote on last edited by
          #6

          Isn’t that the procedure what Stephen Maturin, the Ship’s Surgeon in Master and Commander: The Far Side of World performed on one sailor on deck of the ship?

          Elbows up!

          George KG 1 Reply Last reply
          • RenaudaR Renauda

            Isn’t that the procedure what Stephen Maturin, the Ship’s Surgeon in Master and Commander: The Far Side of World performed on one sailor on deck of the ship?

            George KG Offline
            George KG Offline
            George K
            wrote on last edited by
            #7

            @Renauda said in Brave Doc:

            Isn’t that the procedure what Stephen Maturin, the Ship’s Surgeon in Master and Commander: The Far Side of World performed on one sailor on deck of the ship?

            Link to video

            Not quite, but it's the same idea -decompress the brain.

            This technique goes back a long way.

            https://en.wikipedia.org/wiki/Trepanning

            What's fascinating, to me, at least, is that this ER doc who does not have the training and skills to do a "proper" burr hole was able to get a good result with just the stuff he had at hand.

            "Now look here, you Baltic gas passer... " - Mik, 6/14/08

            The saying, "Lite is just one damn thing after another," is a gross understatement. The damn things overlap.

            1 Reply Last reply
            • RenaudaR Offline
              RenaudaR Offline
              Renauda
              wrote on last edited by
              #8

              In 15 century England, Henry VI underwent trepanning on at least a couple of occasions when he lapsed into madness characterized by prolonged catatonic states.

              Elbows up!

              1 Reply Last reply
              • MikM Offline
                MikM Offline
                Mik
                wrote on last edited by
                #9

                How does it get through the skull or other bone?

                “I am fond of pigs. Dogs look up to us. Cats look down on us. Pigs treat us as equals.” ~Winston S. Churchill

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                • George KG George K

                  Balls. Of. Steel.

                  The device the doc used:

                  https://www.teleflex.com/usa/en/product-areas/emergency-medicine/intraosseous-access/arrow-ez-io-system/index.html

                  JollyJ Offline
                  JollyJ Offline
                  Jolly
                  wrote on last edited by Jolly
                  #10

                  @George-K said in Brave Doc:

                  Balls. Of. Steel.

                  The device the doc used:

                  https://www.teleflex.com/usa/en/product-areas/emergency-medicine/intraosseous-access/arrow-ez-io-system/index.html

                  I work with a country surgeon who I think could do something like that. For where he's at, he's a good knife. And cocky.

                  “Cry havoc and let slip the DOGE of war!”

                  Those who cheered as J-6 American prisoners were locked in solitary for 18 months without trial, now suddenly fight tooth and nail for foreign terrorists’ "due process". — Buck Sexton

                  1 Reply Last reply
                  • George KG George K

                    @Axtremus you have to understand that the skull is basically a closed box and there is no place for tissue to expand if there is a mass such as a tumor, swelling due to an undetermined cause, or bleeding.

                    Something has to move, and the only place it can go is through the hole at the base of the skull called the for Raymond Magnum. When the base of the brain "herniate" through the base of the skull through the Foremen Magnum (which literally means "big hole."), the centers which control breathing heart rate, and even consciousness have their blood supply compromised.

                    Therefore, in acute situations with brain bleeding, it is important to remove any cause of brain swelling that can compromise neural tissue.

                    In this particular case, the optimal treatment would be to take the patient to the operating room make a hole in her skull, and drain the bleeding through that skull. However, in this case, there was no neurosurgeon available and so the emergency room doctor took advantage of the only tools he had to gain access to the hematoma.

                    The IO 10 needle is used to administer fluid fluids through an intraosseous route. That means, if you can't get an IV started somewhere, you insert a large needle into the bone marrow, usually in the front of the shin bone, the tibia. You can then administer fluids through that in a hurry to resuscitate someone.

                    In this case, the ER doc use the IO needle to the blood drain out from the hematoma, decompressing the brain. He had the assistance of a neurosurgeon via telephone to guide him where to place the needle.

                    AxtremusA Offline
                    AxtremusA Offline
                    Axtremus
                    wrote on last edited by
                    #11

                    @George-K ,thank you!

                    1 Reply Last reply
                    • bachophileB Offline
                      bachophileB Offline
                      bachophile
                      wrote on last edited by
                      #12

                      The balls is also knowing where to puncture. I guess they sent a pic of the scan but still, u r basically blind, and what if u go in and brains start spilling out instead of blood. That would be messy.

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