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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 don’t 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

• ARAS—ascending 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