Today, one of my former attendings discusses his successful placement of an EZ-IO burr hole for an epidural hematoma resulting in a live patient going home to their family.
Dr. Grossman's Case Report
Using the Full Neurosurgical Kits
- The Occasional Burr_Hole
- Article on ED Burr Holes that comes out of Scandinavia
- Very nice blogpost on EMDOCS
Case Series
EZ-IO Burr Holes
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9126472/
- https://www.sciencedirect.com/science/article/pii/S235264402200146
- Subdurals
Procedure
- Relative contradiction is coagulopathy (though in the cases we are going to do it, I think even this gets trumped–talk to your neurosurgeon)
- Pick location and needle size based on CT imaging
Additional New Information
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An ED Intensivist from NY.
Professor
Nassau University Medical Center
No conflicts of interest (coi).
Professor
Nassau University Medical Center
No conflicts of interest (coi).
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Hello, regarding a prehospital setting, when you dont have ct-imaging at hand, where would you drill and is this even feasible?
Should you drill more holes if you dont get it first try?
Thanks for the great lecture and greatings from Vienna <3
This is not something anyone anyone should do without a CT scan confirmed diagnosis. this case is a wildly unique circumstance. in a prehospital setting there are countless things that cause coma after blunt head trauma. intubate, hyperventilate, keep the head elevated to 30 degrees, drive fast.
You are correct, John. CT is an absolute requirement prior to considering this…
-Marc
Thanks for posting this, Scott. My hope is as many people as possible see and hear this and consider what they will do when confronted with this situation before it comes up…
This is a really helpful post. I work mostly in critical access hospitals and am aware of one case where this was done by a general surgeon successfully and have long considered this to be something I might be called to. In fact, our group will be teaching just this as a part of a HALO (high acuity, low occurrence) course for the company. There are plenty of times where patients like this can be stuck at the small hospital even if close to the big center….