User:Mr. Ibrahem/Burr hole

Burr hole, also known as trepanation, is a procedure in which a hole is made through the skull. This is done to treat epidural or subdural hematomas when midline shift occurs, the Glasgow coma scale is less than 8, and one pupil has enlarged. While most commonly performed by neurosurgery, It may be done by an emergency physician if the former is not available.

The person is generally intubated before starting. The location of the bleed is confirm on CT scan and the thickness of the overlying skull is measured. The location is than shaved, sterilized, and injected with lidocaine with epinephrine. An approximately 4 centimeter (1.57" inch) long cut down to the bone is made. This is generally done 2 fingers in-front and 2 fingers above the ear canal. A retractor is than used to keep the skin open while a drill is used to get through the skull. With an epidural hematoma the blood may come out or require gentle suction. In a subdural hematoma, the dura should be lifted with a sharp hook and a X shaped cut made in it.

Antibiotics should be given to prevent infection and the person should receive definitive care by neurosurgery. Trepanation is the oldest known type of surgery with evidence of it being performed throughout history. Anthropologists believe it was originally carried out for spiritual purposes, epilepsy, headaches, head wounds, and mental disorders.