This week, I would like to present a case study by Bulstrode et al (Injury, Int. J. Care Injured 48 (2017) 1098–1100) on the use of the EZ-IO drill for drainage of an extradural haemorrhage.
The case is of a 43 yo pedestrian hit by a car at low speed. The patient’s GCS on arrival to the Emergency Department was 14. A CT Brain shows a small frontal contusion and an occipital extradural.
One hour later, the patient’s GCS deteriorated to 8 and the left pupil was fixed and dilated.
A repeat scan demonstrated a large occipital-parietal extradural with midline shift.
The patient was intubated and prepared for transport to a larger facility.
On arrival to the larger centre, the patient went to the operating room. Initially a 25mm 15 gauge intraosseous needle was used, after preparation of the occipital region, to aspirate 30ml of blood.
The patient then had a formal craniotomy and made an excellent recovery.
The procedure took about 8 minutes and did not delay the formal procedure, as the patient was being prepared at the same time.
This is the first time the I/O needle has been used for this purpose. It is perhaps a glimpse of the future for rural emergency department specialists, where patients deteriorate and transport is hours away.
The procedure can have its downside, with a risk of hitting blood vessels and causing further bleeding estimated at about 3%. However remember, that patient is deteriorating and needs drainage. Waiting will kill them.
The Neurosurgical Society of Australia recommends burr holes. In my view this is a safer approach.
The appropriate training is a must, but it is procedure that we can perform in the emergency department, that can make a significant difference.
Peter Kas
