No Neurosurgeon In-House
Neurosurgeons are not always available in-house or at community hospitals. In this situation, contact the patient’s neurosurgeon for an accurate patient history and for discussion regarding further workup and management. For emergent situations, such as in patients with signs of impending herniation, including hypertension, bradycardia, irregular respirations, and/or a fixed, dilated pupil, perform an emergency shunt tap as described n the "Treatment: Shunt Tap" section. Conversely, if the patient has a proximal shunt obstruction that cannot be relieved by a shunt tap, consideration should be made for reaching out to other in-house surgeons (ie, trauma) for assistance in placing a burr hole, as this may be out of the scope of the practice of an emergency physician.
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