Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
  1. Home
  2. Search

Refine search

Refine search

Access:
Content type:
Publication date:
Apply   From and To filters
Subject: Show more
Journals Show more
Publishers: Show more
Societies Show more
Series: Show more
Collections: Show more

Actions for selected content:

Select all | Deselect all
  • View selected items
  • Export citations
  • Download PDF (zip)
  • Save to Kindle
  • Save to Dropbox
  • Save to Google Drive

Save Search

You can save your searches here and later view and run them again in "My saved searches".

Please provide a title, maximum of 40 characters.
Cancel
×

2 results

  • Is Prehospital Endotracheal Intubation Associated with Improved Outcomes In Isolated Severe Head Injury? A Matched Cohort Analysis

  • Efstathios Karamanos, Peep Talving, Dimitra Skiada, Melanie Osby, Kenji Inaba, Lydia Lam, Ozgur Albuz, Demetrios Demetriades
  • Journal:
    Prehospital and Disaster Medicine / Volume 29 / Issue 1 / February 2014
    Published online by Cambridge University Press:
    13 December 2013, pp. 32-36
    Print publication:
    February 2014
  • Introduction

    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.

    Hypothesis

    Outcomes in patients subjected to divergent prehospital airway management options following severe head injury were studied.

    Methods

    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).

    Results

    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.

    Conclusion

    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.

  • Chapter 46 - Paediatric emergencies

  • from Section III: - Organ dysfunction and management
  • Edited by Fang Gao Smith, University of Warwick
  • Edited in association with Joyce Yeung
  • Book:
    Core Topics in Critical Care Medicine
    Published online:
    06 July 2010
    Print publication:
    22 April 2010, pp 360-368

  • Summary

    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).