Keywords: burr hole, trephination, subdural hematoma, epidural hematoma, herniation (PubMed Search)
Your patient presents with a large traumatic subdural hematoma with midline shift and clinical evidence of herniation. Your nearest neurosurgeon is several hours away, what do you do?
Initial resuscitation should follow ATLS. Treatment of intracranial hypertension and herniation includes elevating the head of bed, administering osmotic therapies, optimizing analgesia/sedation, and hyperventilation. If all measures have been exhausted and there is a delay to definitive neurosurgical intervention, an emergency department burr hole may be considered.
Follow us on Twitter @christinap0well @EM_NCC