Dr - Raja S Vignesh (thoothukudi Medical College) In Hospital Care Of Patient By Neurosurgeon 72q24

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 issions 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