Rural Emergency Medicine Podcast Episode 6: Epidural and Suicidal Patients
Jan 11, 2018
Craig Hecock, a clinical psychiatrist from Fort Collins, Colorado, delves into crucial psychiatric emergencies in rural settings. He discusses the alarming rise in suicide rates, particularly the effects of firearm access among vulnerable populations. The conversation highlights the importance of family involvement in assessments and ethical challenges in caring for suicidal patients. Hecock also shares insights on transforming patient care through empathy and the potential future use of ketamine for treating depression in emergency contexts.
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Cowboy's Epidural Hematoma Case
- Treve Henwood shared a memorable case of a cowboy with a large epidural hematoma after a fall from a horse.
- The patient initially returned to work but later collapsed, illustrating the classic lucid interval in epidural hematomas.
Epidural Hematoma Basics
- Epidural hematomas are typically arterial and located between the skull and dura, often accompanied by temporal-parietal skull fractures.
- The classic lucid interval after initial loss of consciousness is key but not commonly seen, requiring high clinical suspicion.
Classic Epidural Herniation Treatment
- For a herniating epidural hematoma without nearby neurosurgery, follow ABCs, intubate, treat elevated ICP, and prepare for rapid transfer.
- Classic treatment includes seizure prophylaxis and spine precautions, but currently ER docs rarely perform burr holes themselves.