Rural Emergency Medicine Podcast Episode 6: Epidural and Suicidal Patients
Jan 11, 2018
Craig Hecock, a clinical psychiatrist from Fort Collins, Colorado, delves into crucial psychiatric emergencies in rural settings. He discusses the alarming rise in suicide rates, particularly the effects of firearm access among vulnerable populations. The conversation highlights the importance of family involvement in assessments and ethical challenges in caring for suicidal patients. Hecock also shares insights on transforming patient care through empathy and the potential future use of ketamine for treating depression in emergency contexts.
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IO Drill for Epidural Drainage
- Using an intraosseous (IO) drill to drain epidural hematoma is a novel temporizing procedure especially viable in rural settings lacking neurosurgery.
- The case report showed that blood aspiration via IO needle decreased pupil size prior to definitive craniotomy.
Performing IO Drainage Safely
- Use CT to localize the hematoma and measure distance to ensure the IO needle length is adequate before insertion.
- Leave the IO needle in place after aspiration to allow continued pressure relief if necessary during transport.
Confirm Localization and Expedite Transfer
- If unsure of needle placement and without neurosurgeon guidance, place a radiology marker on the scalp and rescan with CT to localize the burr hole or IO insertion point.
- Start transport arrangements immediately and do not let the procedure delay transfer to a higher care center.