Archives for March 6, 2005

ER doc, rescue celebrated; Drilled hole in patients’ head with Power tool

I’m late to this story, but as I Googled around it hadn’t gotten much press, so it might be news to you, too.
Idaho Mountain Express : ER doc, rescue celebrated: Improv procedure saves the day

St. Alphonsus Life Flight paramedics Tammye Erdmann and Blaine Patterson first met Ben King on Dec. 5, 2003, as he was dying on a stretcher in a church parking lot in Shoshone.

The next time they saw him was Friday, April 23, at a reception at St. Luke’s Wood River Medical Center in Ketchum. The event was organized by the hospital to recognize Dr. Kieth Sivertson, St. Luke’s emergency department director, and the extensive medical effort that went into saving King’s life.

King was suffering an inner-cranial [sic] bleed caused by the trauma of falling down a flight of stairs in their Hailey home. Despite the heroic efforts of his wife Melissa, who found him, and hospital staff, King needed a neurosurgeon. The nearest at the time was in Boise.

Standing around the stretcher in Shoshone, the medical personnel were preparing Melissa King for the worst. Then Sivertson decided to take a drastic measure: He relieved the pressure on King’s brain by drilling a hole in his skull with a Makita drill, a power tool found on most construction sites.

“It sounds like an outrageous cowboy move,” Sivertson said. “But, it was a calculated risk. We will risk a lot to save a life.”

“Idaho is one of the last places you can find (where) you’re entitled to do yourself harm,” he said, explaining that medical attention, especially emergency medical help can not reach victims here as quickly as it might in a large city. “If you’re counting on getting a second chance, forget it. You don’t get to choose how you die. You get a chance to choose how you live. Your life can change just that quickly,” he said, snapping his fingers.

Sivertson said, for example, if a person who is allergic to bees gets stung at the blinking light at the intersection of State Highway 75 and U.S. 20. and has a systemic reaction, he or she will die. Emergency services would not be able to get that person to a hospital in time.

As part of the reception, Makita T-shirts were exchanged, and Sivertson received a Makita drill with a plaque attached to the box for his efforts. …

In addition to a Makita T-shirt with autographs of everyone who contributed to saving King’s life, Sivertson also gave the survivor a Makita baseball cap with a bull’s eye by the temple for any future emergencies.

“I owe my life to everybody here,” King said, including his wife, the first person he saw when he awoke. “I owe my life to you. I feel fantastic.”

First off, the patient is alive, so this is a win! I don’t know enough of the circumstances to know if this was “an outrageous, cowboy move”, but clearly it worked.

I have never, and really pray I never need to, perform an emergency burr hole to relieve the pressure on a brain; this was a bold move, and Dr. Sivertson is to be commended for cool thinking and the fortitude to act.

During my training we had one of those ‘around the desk’ educational chats about emergent burrholes, and it went “three fingers above the ear, two or three fingers in front of that, and make a hole on the side of the first pupil that blows“. (This seems backwards from what you’d expect: pressure on one side of the brain should shove it away, causing the opposite side pupil to blow when the nerves gets compressed on the tentorium, you’re thinking, as did I; however, we’d be wrong. The pressure is causing an uncal herniation syndrome that starts to compress the nerves on the side nearest the lesion first; the opposite pupil dialates as a very late finding).

The article is very oddly written, and it’s not clear whether this patient was being transferred from a hospital to another when this happened (which I think is the case), or whether this was a prehospital move. If it was an interhospital transfer, Dr. Sivertson may have had a CT scan to show the hematoma, but maybe not. I’ll try to find out more.

In the mean time, here’s an article entitled, appropriately enough “The occasional burr hole“. I like their #1 under the procedure heading:

You need:
(1) A sense of historical proportion. Drilling a hole in the head is just the boring (sorry) start to most neurosurgical days. Trephination was practised safely in the Stone Age. So relax.

I wouldn’t be very relaxed, but that’s just me.

hat tip: LizDitz