Two and a half hours later you are still waiting for the MRI scan to become available. You are becoming agitated as you notice the patient’s GCS may be dropping a little. You phone the radiologist to ask if a CT head would have been a better option.
“Have you never read a thing called NICE guidelines?”, she says condescendingly. “Well I’ll tell you what it says. It clearly states that in a suspected intracranial bleed of someone on warfarin you do a CT scan which is faster”, she says. “Please do your homework next time and send the patient up immediately for a CT scan”.
The patient is sent for a CT scan after wasting hours waiting for the MRI. This still saves some time. You make a mental note that although MRI has advantages, CT head is usually more readily available in the acute setting.
The results from the CT head are back. You see a crescent shaped lesion as expected and you pat yourself on the back. On to managing it now…
The patient is still in A&E and their state of confusion prompts you to do something urgently to help them. You knew that the management of a symptomatic subdural haemorrhage might involve a burr hole. Given the inexperience to assess whether this will require a burr hole or not and the obvious lack of ability to perform one yourself (no offence) what should you do next?
Start mannitol in A&E whilst speaking to neurosurgery