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HOSPITAL CARE OF PATIENT BY A

NEUROSURGEON

DR.RAJA.S.VIGNESH M.S.M.CH
SENIOR ASSISTANT PROFESSOR
THOOTHUKUDI GOVERNMENT MEDICAL COLLEGE
THOOTHUKUDI
ROLE OF A NEUROSURGEON IN OUR SET UP

No direct admissions or first treatment


provider.
Sub/super specialist
A opinion consultant who then manages the
case
CITY VERSUS PERIPHERY

Large cities (rather ) institutions have dedicated NS


ICU, step down ward, theatre and equipment stay duty
NS, NS residents, and so on

Smaller GH have a SHARED setup from theatre to a


general ICU and call duty NS
TIME TO GET A CT DONE

Highly variable few minutes to hours or worst a day


Even within the same institute differs
Monday versus holiday .. Call duty tech versus Stay duty tech
GCS 15 versus poor GCS versus alcohol
Bias ..under the influence of alcohol
Patient without attenders ..to get a free CT the official procedures to be
followed
Associated other injuries which restrict transport of Patient to the scan
room. (including man power and infra structure )
WHAT HAPPENS WITH A DELAYED CT

Obviously the morbidity and mortality


increases.
Many preventable NS causes of death ..lives
lost and the resultant burden
THEATRE AND EQUIPMENT

Peripheral centres have no dedicated OT table/theatre


ascertained for NS exclusively
Many times the patient is ready, the NS is ready anaesthetist
available ..but the anaesthetist is held up due to OG cases
or GS cases..
Delay in surgical intervention--Mortality and morbidity rise
SPINE INJURY

They are devastating and take a toll in the quality of life of the
patient and the caretakers both socially and economically as
well
Paramedics at the rescue site.NO Philadelphia collar
Transport deaths or worsening of the existing injury and finally
dismal outcome
C-ARM AND IMPLANTS

Most EOT dont have C arm


No Stabilisation implants in EOT
Even when the NS is available he is not of use to
MY OBSERVATIONS WITH REGARDS TO NS TRAUMA

Better outome
Pre hospitalisation rescue site Philadelphia collar
CT to be done at arrival in casualty after necessary initial CAB stabilisation if
required
All intoxicated must undergo CT.
Necessary changes to authorise the CMO to order the FREE CT when no
attenders are available and laws to protect the CMO with regards to consent
issues

NS

All NS available centres to be equipped with necessary


infra structure for ns work in trauma EOT
From ventilators, C-arm, Craniotomes
For NS treatment should be a basic standard care for
anyone who gets it irrespective of being in metro GH or
peripheral GH
IDEAL OR A BETTER NS TRAUMA SET UP

Early CT or MRI
Free CT without hitches
Dedicated separate OT table with necessary NS equipment
and trauma anaesthesiologist just like CEMONC set up.
CONTINUED

Casualty,
ER ward,
CT/MRI,
BLOOD BANK and OT
IN THE SAME AREA
This area should constitute a TRAUMA set up.
SOME VIDEOS THAT DEFINE THE TOPIC

Appropriate consent obtained from


individuals and their attenders for use in
medical education forum
TRAUMATIC PARAPLEGIA

10TH POD AFTER 3 MONTHS


UNKNOWN ..
AFTER ONE MONTH
IMMEDIATE POST OP
40 DAYS
AFTER 6 MONTHS
WHAT'S NEW ROOMING IN

ARASascending reticular activation system


What it does ..gives real time impulses to the higher cortex from within and outside the body..
In my miniscule experience with severe HEAD injury patients 7 years ,patients taken care by close
relatives do far better than nursing staff care alone
Familiarity with sounds, touch ,vision, affection and extra sensory perception may be the reason
I practise from Day 1 the concept of ROOMING IN of severe Head injury patients along with their close
relatives in the ICU f they are hemodynamically stable and good respiratory efforts.
The infection rate is low .they do near 24 hours physiotherapy ,DVT etc are low.
I am doing a pilot study on this and collecting data which I hope to publish in another 5 years .
ROOMING IN

I practise from Day 1 the concept of ROOMING IN of severe Head injury


patients along with their close relatives in the ICU itself if they are
hemodynamically stable and good respiratory efforts.
Transfer to the step down ward or even normal ward at the earliest.
The infection rate is low .they do near 24 hours physiotherapy ,DVT etc
are low.
I am doing a pilot study on this and collecting data which I hope to publish
in another 5 years .
SOCIAL RESPONSIBILITY
UNKNOWN TO KNOWN-42ND DAY
FELICITATION
QUESTION HOUR

Thank you for your patience


I am proud to be GH doc serving rural NS patients