Monthly Archives: December 2009

Thoracostomy in blunt traumatic arrest

37 patients with blunt traumatic cardiac arrest underwent attempted resuscitation by a HEMS crew over a four year period. Chest decompression was performed in 18 cases (17 thoracostomy, one needle decompression). The procedure revealed evidence of chest injury in 10 … Continue reading

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Not such a B.I.G. success in the field?

Success rates with the bone injection gun were 71% (10 out of 14) in children <16 years and 73% (19 out of 26) in adults. Less encouraging data than that seen with the EZ-IO device, and consistent with the experience … Continue reading

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Ballistic penetrating neck injury and the risk of immobilisation

British military physicians reported the outcomes of patients sustaining penetrating neck injury from the Iraq and Afghanistan conflicts. Three quarters were injured in explosions, one quarter from gunshots. Of 90 patients, only 1 of the 56 survivors to reach a … Continue reading

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Prehospital Hypocapnia and Poor Outcome After Severe Traumatic Brain Injury

Patients admitted to a level 1 trauma centre with traumatic brain injury whose end-tidal CO2 was kept with the Brain Trauma Foundation recommended limits of 30-35 mmHg (3.9-4.6 kPa) had a lower mortality than those whose CO2 was outside this … Continue reading

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No benefit from drugs in pre-hospital cardiac arrest

A Norwegian randomised controlled trial over five years compared out-of-hospital nontraumatic cardiac arrest outcomes between ACLS protocols with and without access to intravenous drugs (epinephrine/adrenaline, atropine, amiodarone). Patients randomised to the drug group had a higher rate of hospital admission … Continue reading

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Characteristic ECG signs of LAD occlusion without ST elevation

In a single centre observational study over 10 years of patients undergoing acute PCI of the left anterior descending (LAD) artery, 35 of 1890 (2%) had a distinct non-ST elevation ECG pattern. The ECG showed ST-segment depression at the J-point … Continue reading

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Is cervical spine protection always necessary following penetrating neck injury?

This short cut review in the Best Bets format attempted to answer the question: “is cervical spine protection always necessary following penetrating neck injury?” From the available evidence they draw the following conclusions: In stab wounds to the neck (with … Continue reading

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Spinal imaging and immobilisation may be unnecessary in many GSW patients

A retrospective review of 4204 patients sustaining gunshot wounds (GSW) to the head, neck or torso examined the incidence of spinal cord injury and bony spinal column injury required operative spinal intervention. None of the patients demonstrated spinal instability requiring … Continue reading

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Cuffed tracheal tubes for children

In a prospective randomised controlled multi-centre trial, cuffed tracheal tubes were compared with uncuffed tubes in 2246 children aged from birth to five years undergoing general anaesthesia. There was no significant difference in post-extubation stridor but the need for tube … Continue reading

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First Aid for Burns

A review of burn first aid treatments highlights the paucity of evidence on which to make firm recommendations. The authors recommend using cold running tap water (between 2 and 15 degrees C) and to avoid ice or alternative therapies. The … Continue reading

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