Place patient supine
Select optimal site based on location of hemorrhage on CT (if unsure, use temporal site)
Temporal - 2 finger-breadths above and 2 finger-breadths forward of the auditory canal
Parietal - over parietal eminence
Frontal - 10 cm above eye in mid-pupillary line (about 3 cm from sagittal suture)
Shave scalp widely over selected site
Cleanse skin with chlorhexadine or betadine and drape in sterile fashion
Set drill depth based on thickness of skull (as measured on CT)
Make ~3cm incision and dissect down to bone with scalpel (control bleeding with direct pressure or electrocautery)
Dissect periosteum off bone with scalpel
Apply retractors to maintain field
Apply drill perpendicular to skull and begin drilling while applying firm pressure
Have assistant apply gentle saline wash to drilling site
Continue drilling until loss of resistance felt or drill bit stops spinning (when using "clutch"-type drill bit)
Use hooks to remove any remaining bone fragments
Preserve skull fragments in container of sterile saline
If subdural hematoma, elevate dura with sharp hook and make careful incision with scalpel
Allow blood to drain freely (gentle suction may be used, but DO NOT suction brain tissue)
Once blood flow slows/stops, apply loose dressing (DO NOT tamponade bleeding)
Temporal - 2 finger-breadths above and 2 finger-breadths forward of the auditory canal
Parietal - over parietal eminence
Frontal - 10 cm above eye in mid-pupillary line (about 3 cm from sagittal suture)
Have assistant apply gentle saline wash to drilling site
Preserve skull fragments in container of sterile saline
Burr hole
Ranula
Nasal septal hematoma
Pinguecula
Frontal sinus fracture
Ear foreign body
Nasal fracture
Conjunctival laceration