European journal of emergency medicine : official journal of the European Society for Emergency Medicine
-
The objectives were to demonstrate the extra workload for emergency medicine of inpatient management of mild/moderate head injuries and to determine the effectiveness of current computed tomography guidelines. ⋯ Implementation of the Galasko report has resource, manpower and training implications for emergency medicine. The current computed tomography guidelines should be modified to include Glasgow coma score<15 and neurological symptoms for example, vomiting and alcohol-related falls.
-
A prospective study was conducted to examine clinical practices in the management of head-injured patients preinception and postinception of the Scottish Intercollegiate Guidelines Network guidelines. Comparison was made between the Scottish Intercollegiate Guidelines Network and National Institute for Clinical Excellence guidelines on their indications for computed tomography scanning. Information was available on 2827 adult patients. ⋯ Four hundred and seventy-eight patients fulfilled one or more National Institute for Clinical Excellence criteria for scanning. No patient with Scottish Intercollegiate Guidelines Network or National Institute for Clinical Excellence indications for computed tomography scanning and who was not scanned, subsequently required neurosurgical treatment for a complication related to their injury. Full compliance with the scanning recommendations in the Scottish Intercollegiate Guidelines Network and National Institute for Clinical Excellence guidelines will require a significant increase in scanning resource and is unlikely to lead to the identification of a significant additional number of patients with intracranial lesions requiring neurosurgical intervention.
-
Identification of pneumothoraces is essential during the initial assessment of major injury. Prompt intervention is crucial for effective resuscitation and for subsequent safe management. Historically, emergency departments have relied on chest X-ray for detection of pneumothoraces. More recently, the increasing availability of computed tomography (CT) has provided a more sensitive means of detection. Occult pneumothoraces are those that are missed on clinical examination and chest X-ray, but are detected on subsequent CT. ⋯ A sufficiently high proportion of pneumothoraces is missed on chest X-ray to advocate a low threshold for use of CT in the early assessment of blunt trauma patients, especially if mechanical ventilation is required for ongoing management.
-
Multicenter Study
Adherence to resuscitation guidelines during prehospital care of cardiac arrest patients.
The impact of prehospital care after the return of spontaneous circulation in out-of-hospital cardiac arrest patients is not known. This study describes adherence to the resuscitation guidelines, factors associated with poor adherence and possible impact of prehospital postresuscitation care on the outcome of out-of-hospital cardiac arrest. ⋯ Less than 50% of out-of-hospital cardiac arrest patients received prehospital postresuscitation care compatible with the current guidelines. Markers of poor prognosis were associated with unsatisfactory care, which in turn was more frequent among the patients who did not survive to hospital discharge. The importance of the guidelines should be highlighted in the future.
-
Intracranial stab wounds are relatively uncommon, as the adult skull usually provides an effective barrier to penetration. We present an interesting case of a penetrating intracranial stab wound with several important teaching points. ⋯ Several leaning points exist in this case. Firstly, as stab wounds to the brain frequently present as apparently innocuous facial or scalp lacerations, a high index of suspicion is needed to prevent these injuries presenting with serious late infective complications. Secondly, reports of similar cases in the literature suggest that stab wounds to the temporal region are associated with a high morbidity and mortality. This case demonstrates that a patient with an injury such as this can occasionally make a good functional recovery. Finally, this case highlights the advantage of magnetic resonance imaging over computerized tomography in patients with these injuries once it has been established that there is no residual intracranial metal fragment prior to magnetic resonance imaging. In this case, the entire wound tract was only evident on magnetic resonance imaging and not on the initial computerized tomography scans.