63.6 Making burr holes

Treatment is urgent. As soon as you have made the diagnosis tell the theatre staff that the patient is coming. He should be on the operating table within a few minutes of the diagnosis being made. If his respiration is failing, operation is very urgent indeed. There have been times when burr holes have had to be made without asepsis, before even the theatre could be reached. Don’t try to raise flaps—they are not necessary for emergency surgery.

ALPHONSE (22 years) fell out of a truck. Six weeks later he went to a health unit complaining of a severe headache. Fortunately, the health unit had a radio, and the pilot from the local mission hospital was in the area, so he was able to call and pick up the patient. By the time the pilot arrived the patient was in coma, but a medical student who was doing his elective, and who met the plane, obtained the history that he had previously fallen out of a truck. The signs of cerebral compression were classical. He was on the operating table within 2 hours, burr holes were made, and he was sitting u conscious the following day. LESSON A chronic extradural haematoma can follow a head injury incurred weeks, or even months, before.