Quick draw: to immediately drain a traumatic extraxial brain hematoma!

A RTA (UK) or MVA (US) brain injury (TBI) ,  is a known disease that surpasses many according to the country, in my country many are brain hematomas and in another countries are spinal cord injury the cinematic and etiology are different, now beyond me, but I think maybe it depends on the car/motorbike ratio according to every country! (for sure).

If a patient brought to ER, with an increased pupil size unilaterally ( of course MUST be checked by a well trained neurosurgeon) the most important thing to do medico-legally or right by the book! is to do a Brain CT scan!,  that takes time, to make proper investigations, that takes time too, so what to do, wait for everything to be ok and the anestesiology to say ok! and operate. This is a well known routine! and the result are well discussed on many series.

But what if we set the bar higher, be more aggresive I mean, should series say that or explain this somehow I haven't find this so far. I propose that patient like that benefit for an immediately evacuation at ER with a burr-hole and since the hematoma is fresh, then a sucker (vaccum system) connected to a feeding tube (10+) would be more that enough to get the job done! and try to do it in the four sides (N-S-E-W). Then do CT and later operate accordingly.

Everybody will say this is very wrong, but stop! and think for a moment if he/she was your close relative would you do it!, I will do it without any doubts. Furthurmore, there are many procedures that are done on ER why can this be another one, it is widely known that a burr-hole is a bed procedure, so why not do it!.

Maybe somebody is doing now this while I writting this, but now it is not accepted in many Neurosurgical Communities or Societies. We have to higher the bar by lowering our demands, our goal is to preserve the brain function whatsoever!, the brain is not like another tissue, not tolerates blood perfussion drooping, and not recovers from beyond a point.  So I encourage you to set the bar together!.

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