An elderly patient presented to the emergency department via ems from an outside hospital with headache and altered mental status.The patient was intubated on transfer to this facility.The patient's wife reported he experienced a sudden onset headache at home.They were preparing to go to the local emergency department when his symptoms became so severe that he asked for an ambulance.The patient has a history of hypertension on no medication.A ct was performed and the patient was found to have cerebellar iph with ivh and hydrocephalus.The following day, the patient underwent suboccipital craniectomy, expansile duraplasty with hematoma evacuation.The patient's head was placed in a mayfield skull clamp in locked position.The patient was turned from supine to prone.The clamping mechanism was not working appropriately and a slight slip of the mayfield pin resulting in a small scalp laceration (2cm).This was irrigated thoroughly and stapled to approximate the scalp without any further issues.The procedure was completed and the patient remains critically ill in the hospital.The mayfield had been applied correctly.The surgeon reported the rocker pin arm was locked but the rocker had loosened after positioning the patient from supine to prone.It remained loose after trying to reapply the same clamp.This was addressed by the surgeon who removed the mayfield clamp and applied a new one which worked without issue.The small laceration was then cleaned and stapled.No adverse sequela was noted.The defective clamp was removed from service and the manufacturer was notified.
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