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Location to DrillĮmergency department skull trephinations are done in the temporal location 2 cm anterior and 2 cm superior to the tragus. The patient was running around the emergency department with no deficits and gave me a hug. One month later, the mother brought the boy back to the emergency department. We placed a sterile dressing on the wound, and the helicopter team transported the patient to the pediatric trauma center. I performed the burr hole with the technique described below and evacuated 150 mL of blood. I had seen one of these in residency and went to the supply room to find the newly arrived burr hole kit, took a deep breath, then started to prepare for the procedure by reviewing the CT. He said, “I’ve never done one of those-it’s up to you.” During the conversation with the trauma surgeon at the major academic center, I told him I was planning on doing an emergent burr hole. I intubated him and called the nearest pediatric trauma center (one hour away) to begin arranging for helicopter transport. His pupils quickly became significantly worse at 6 mm and 2 mm, and he became unresponsive. A head CT revealed a large epidural hematoma with midline shift. After a period of observation, he became increasingly somnolent, and on repeat exam, his pupils were slightly unequal. He initially appeared well and was running around the triage room.
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How to Perform Ultrasound-Guided Forearm Nerve Blocks to Provide Non-Drug Pain Relief for Acute InjuriesĮxplore This Issue ACEP Now: Vol 36 – No 12 – December 2017 The CaseĪ 2-year-old male was brought to the emergency department by his mother after falling out of a shopping cart seat and striking his head.Emergency Medicine Residents Perform Marathon Resuscitation.Emergency Physician Solves Malfunctioning LVAD with Electrician Skills.