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No, I don’t give TXA to kids with isolated headinjuries We want to stop any clot breakdown to try and slow any potential bleeding. The primary outcome was 28-day mortality – TXA improved survival with no increased risk of cerebral clots. What about headinjury , though? This is not good.
We have mentioned the Glasgow Coma Scale in multiple delicious morsels: Minor closed headinjuries in <3 month olds and in the rebaked morsel , Blunt cerebrovascular injury , Cerebral edema in DKA , Pediatric Trauma Pitfalls , and Carbon monoxide poisoning.
Ann Emerg Med 2017 [6] This was a retrospective database review of 7521 traumatic brain injury patients SBP target ≥90mmHg resulted in a mortality of 7.8% vs SBP target <90mmHg which resulted in a mortality of 33.4% NEJM 1994. [2]
Comparison of PECARN, CATCH, and CHALICE rules for children with minor headinjury: a prospective cohort study. He is a […] The post SGEM#412: I Can’t Choose…from all the HeadInjury Prediction Rules first appeared on The Skeptics Guide to Emergency Medicine. So, should we CT scan children with minor headinjury?
The potential for soiled airways, cervical spine injuries, maxillofacial injuries and headinjuries combined with agitation/delirium, altered mental status and hypoxemia can make securing a definitive airway both an anatomic and physiologic challenge. Traditional RSI entails preoxygenation followed by.
Although many of these injuries were managed within hours, a growing number were delayed by a few days to improve outcomes. The mortality trends do not appear to be related to injury grade, overall injury severity, or the presence of headinjury.
One-liner… Traumatic brain injury (TBI) is a leading cause of mortality and morbidity in paediatric populations, and fever is associated with worse outcomes. A 12-year-old boy presents with a significant headinjury following a road traffic accident. Four RCTs showed no significant difference in mortality or outcomes.
1, 2 Its occurrence often portends worse outcomes in intubated patients, whose projected hospital course was already tenuous. 3, 6 Among patients with stroke or traumatic brain injury (TBI), the risk may be as high as 28%-76% and 23%-60%, respectively. 4, 8 Paper: Dahyot-Fizelier, C.,
The Pennsylvania Trauma Outcomes Study database contains a huge amount of data. This represents when after arrival, patients start dying due to their injuries. Penetrating injury plus hypotension kills the fastest at 19 minutes and headinjuries the slowest at 1:20.
Here are the factoids: The original data were derived from a 17-center study conducted from 2018-2020; this study only included 1,387 patients who had pelvic fractures (as well as other injuries). The primary outcome was the development of VTE during the hospitalization.
Spoon Feed In adults presenting to EMS after OHCA, those receiving epinephrine prior to advanced airway management (AAM = supraglottic airway, SGA, or endotracheal tube) experienced better outcomes and prehospital ROSC than those receiving AAM before epinephrine. This was true for both shockable and non-shockable initial rhythms.
Bottom line: This is an intriguing abstract, pointing me to the original paper published in NEJM. This multi-center study was performed in conjunction with the research coordinating center at Johns Hopkins, which designs some top-notch research.
Maybe injuries to the spleen or kidney come to mind. Perhaps thoughts of pelvic injuries or severe headinjury dominate our considerations. Long-term Outcomes and Health Perceptions in Pediatric-onset Portal Hypertension Complicated by Varices. Semin Liver Dis. 2023 Feb;43(1):100-116. doi: 10.1055/s-0042-1759613.
Secondary outcome analysis showed there was no difference in length of hospital stay, ICU stay, or duration of oxygen therapy. This is what they found: Length of hospital stay (time from randomisation to the time of hospital discharge or death), the primary outcome, was significantly longer in the high-flow group at 1.77
He is also the CME editor for Academic Emergency Medicine Case: You’re working in a small rural emergency department when a seven-year-old girl comes in by EMS with a headinjury. She hit a rock, and went over the bars, striking her head on a small tree as she fell. Corey Heitz is an emergency physician in Roanoke, Virginia.
In this Part 1 of our 2-part EM Cases podcast series on Geriatric Trauma, Dr. Barbara Haas, Dr. Camilla Wong and Dr. Bourke Tillman answer questions such as: why are older patients under-triaged to trauma centers and how does that affect outcomes? Which older patients do not require head or c-spine imaging after a ground level fall?
NEJM June 13 2024; doi:10.1056/NEJMoa240360 Clinical Question In adult patients with moderate or severe traumatic brain injury, does a liberal transfusion strategy (transfusion if haemoglobin <10g/dl) compared to a restrictive strategy (transfusion if haemoglobin <7g/dl) reduce the rate of an unfavourable Glasgow Outcome Scale – Extended, (..)
4] We also know that severe TBI is commonly associated with the development of intracranial hemorrhage where the presence and volume of blood are associated with increased mortality and poor outcomes.[5] Association between prehospital tranexamic acid administration and outcomes of severe traumatic brain injury. JAMA Neurol.
PMID: 39382241 Clinical Question In patients with acute brain injury, does a liberal, compared to a restrictive strategy of blood transfusion, improve neurological outcomes at 180 days? Background The TRICC study, published over 20 years go, led to the widespread adoption of restrictive thresholds for blood […]
American Journal of Hematology Jan 2023 * Population: Children aged 3-21 years old, with sickle cell disease (Hemoglobin SS disease or Hemoglobin Sβ Thalassemia) who presented with vaso-occlusive pain episodes to * Excluded: Children with upper respiratory infection, concern for stroke or altered mental status, or headinjury, acute chest * Intervention: (..)
Excluded: Oropharyngeal trauma combined with other severe headinjury or multisystem trauma, not primary research, non-English publication * Intervention: CTA * Comparison: No CTA * Outcome: radiologic and clinical outcomes including infection, injury to vasculature, cerebrovascular injury, and neurologic abnormalities.
r4 case follow-up WITH DR. milligan CC: Found down The case: A young F was found down in a snow bank after a GSW to the head. She presented with a core temp of 30C and her CT scan did not show a devastating headinjury as was expected. EMS had reported she had coded en route. She regained pulses with warming on arrival.
Effect of Out-of-Hospital Tranexamic Acid vs Placebo on 6-Month Functional Neurologic Outcomes in Patients With Moderate or Severe Traumatic Brain Injury. Case: A 42-year-old helmeted bicycle rider is involved in an accident where he hits his head on the ground. Reference: Rowell et al. Reference: Rowell et al.
In an attempt to improve resource utilization, emergency department length of stay, limit cost and improve outcomes, there have been multiple Clinical Decision Rules (CDRs) created to help guide clinicians in their decision-making process. Traditionally CT imaging was obtained for fear of missing intracranial pathology.
Outcome: Primary Outcome: All-cause mortality at 90 days. The primary outcome focused on patient-centered outcomes. The outcomes were predominantly binary and objective, reducing the potential for subjective interpretation and bias. 97% of patients sustained blunt trauma.
Background: Sports-related concussions are among the most common injuries in children and adolescents, affecting millions of youth athletes annually. Historical practice recommends rest to prevent adverse outcomes; however, evidence suggests strict rest is harmful. Symptom reporting was the most common outcome in the included studies.
A 6 yo girl had significant trauma from an MVC, with headinjury (initial GCS 10, but no intracranial bleeding) and mild orthopedic injuries. Inpatient stay : She quickly awoke and was observed for a couple days, treated for minor orthopedic injuries, and recovered well from the headinjury.
The evidence for TXA providing a patient-oriented outcome (POO) has been mixed. It seems to work for epistaxis ( SGEM#53 and SGEM#210 ), failed to demonstrate a decrease in all-cause mortality in post-partum hemorrhage ( SGEM#214 ), and did not result in an improved neurologic outcome in hemorrhagic strokes ( SGEM#236 ). TXA vs. 19.8%
This is part of Oh’s Manual Chapter 77 on headinjury and we covered ICP monitoring before in number 20. This is part of Oh’s Manual Chapter 77 on headinjury and we covered ICP monitoring before in number 20. Welcome back to the tasty morsels of critical care podcast. The following summarises some of the headlines.
Whilst you were busy managing headinjuries and drownings, Ranulf had been out with a group of boys from school this evening. The primary outcome measure was chest drain failure, i.e., retained haemothorax requiring a secondary interventional procedure. Back in ED with Ranulf, and pack two has gone through. J Pediatr Surg.
We hypothesized that there is a specific coagulopathy of ITBI, detectable using functional coagulation tests and that coagulopathy is associated with worse outcomes including raised intracranial pressure (ICP), progression of intracranial haemorrhage (PICH), and mortality.
Abusive headinjury is the most common cause of death from child abuse. Up to 30% of infants with abusive headinjury may be misdiagnosed on initial presentation. Factors associated with adverse outcomes in children with diabetic ketoacidosis-related cerebral edema. Louwers et al. J Emerg Med. 2012; 43(1): e49–e51.
The world is a strange place when we can’t do something so simple when it’s critical, but we do it so well when the outcomes are meaningless. The ED team had just finished an in situ simulation where the focus was on rapid sequence intubation (RSI) in headinjury, and using the new intubation checklist.
Flooding him with crystalloid is going to dilute his clotting factors, make him hypothermic and potentially worsen outcomes. Check his pupils – any signs of headinjury or subdural from flying debris? Even EMST-ATLS has (at last) moved away from the old mantra of “two litres of crystalloid, stat”.
A second primary outcome was added at the 30-month time frame by request of the FDA, the trial was still blinded at that time. A second primary outcome was added at the 30-month time frame by request of the FDA, the trial was still blinded at that time. POWER: 86% to detect a 1-point difference in the group’s first primary outcome.
r4 Capstone WITH Dr. Stark Learn from your poor patient outcomes. isolated headinjury, asphyxia or any other cause of a likely hypoxic respiratory arrest blunt cardiac injury underlying medical cause for the arrest Role of US in TCA? meanwhile, pseudo-PEA may be associated with a favorable outcome.
Primary Outcome: Discharged home from the ED Secondary Outcomes: There were several secondary outcomes. Another interesting secondary outcome that could confound the results is that children who received IN fentanyl received higher overall total parenteral opioid morphine equivalents. Am J Hematol.
Long-term pain prevalence and health-related quality of life outcomes for patients enrolled in a ketamine versus morphine for prehospital traumatic pain randomised controlled trial. Trench entrapment: is ketamine safe to use for sedation in headinjury? Emergency Medicine Journal. 2014 Dec;31(12):1029. 2014 Oct;31(10):840–3.
Included in this differential is transient epileptic amnesia, transient ischemic attack, stroke, metabolic disorders, psychogenic disorders, and post traumatic amnesia. We did the March episode at the end of last month and the April episode is the first week of this month.
We aimed to identify variables that are associated with adverse outcomes in older patients admitted to a trauma centre for an isolated orthopaedic injury. Conclusion We identified eight predictors of adverse outcomes in patients >64 years of age admitted to a trauma centre for orthopaedic injury.
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