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Prehospital endotracheal intubation (ETI) following traumatic brain injury in urban settings is controversial. Studies investigating admission arterial blood gas (ABG) patterns in these instances are scant.
Outcomes in patients subjected to divergent prehospital airway management options following severe head injury were studied.
This was a retrospective propensity-matched study in patients with isolated TBI (head Abbreviated Injury Scale (AIS) ≥ 3) and Glasgow Coma Scale (GCS) score of ≤ 8 admitted to a Level 1 urban trauma center from January 1, 2003 through October 31, 2011. Cases that had prehospital ETI were compared to controls subjected to oxygen by mask in a one to three ratio for demographics, mechanism of injury, tachycardia/hypotension, Injury Severity Score, type of intracranial lesion, and all major surgical interventions. Primary outcome was mortality and secondary outcomes included admission gas profile, in-hospital morbidity, ICU length of stay (ICU LOS) and hospital length of stay (HLOS).
Cases (n = 55) and controls (n = 165) had statistically similar prehospital and in-hospital variables after propensity matching. Mortality was significantly higher for the ETI group (69.1% vs 55.2% respectively, P = .011). There was no difference in pH, base deficit, and pCO2 on admission blood gases; however the ETI group had significantly lower pO2 (187 (SD = 14) vs 213 (SD = 13), P = .034). There was a significantly increased incidence of septic shock in the ETI group. Patients subjected to prehospital ETI had a longer HLOS and ICU LOS.
In isolated severe traumatic brain injury, prehospital endotracheal intubation was associated with significantly higher adjusted mortality rate and worsened admission oxygenation. Further prospective validation of these findings is warranted.
KaramanosE, TalvingP, SkiadaD, OsbyM, InabaK, LamL, AlbuzO, DemetriadesD. Is Prehospital Endotracheal Intubation Associated with Improved Outcomes In Isolated Severe Head Injury? A Matched Cohort Analysis. Prehosp Disaster Med. 2013;28(6):1-5.
Deliberate self-poisoning is usually an intentional oral ingestion of a variety of drugs by previously well adults and makes up 95% of cases. This chapter explains airway and breathing, and circulation in the initial assessment and resuscitation phase. In the clinical examination the patient's symptoms and signs elicited on physical examination provide clues to the most likely drugs involved and guide early therapy especially when the cause is unidentified. The chapter lists out various investigations that include electrocardiogram, arterial blood gases, radiology and drug screening. The importance of maintaining physiological stability whilst minimizing the toxic effects of drug ingestion is paramount. The toxicity can be diminished by preventing drug absorption, inhibition of toxic metabolite formation, and augmentation of drug elimination. The general care of the unconscious patient includes regular monitoring of vital signs and organ support. The chapter lists out management of specific drugs that include salicylates (aspirin).
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