Arterial lines in the field? You’ve got to be nuts, or…..French! Yep, the SAMU boys and girls put in 94 arterial lines in pre-hospital cases over two years, and found big differences between invasive and non-invasive arterial pressures in systolic and diastolic pressures. What about mean pressures though, which we’d expect to be more closely correlated? They didn’t say. An interesting paper, but I don’t think I can use it.
Emerg Med J. 2009 Mar;26(3):210-2
Invasive arterial blood pressure monitoring in an out-of-hospital setting: an observational study
German trauma patients are more likely to survive if they have a whole body CT rather than selective scans. Or that’s what this paper would have you believe IF you’re happy with the retrospective comparison, multivariate adjustments, and potential confounders. Still, if it helps you get your radiologists to play ball, the reference is…
Eﬀect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study
Lancet. 2009 Apr 25;373(9673):1455-61
A comprehensive review of the literature, the findings of which showed ‘compelling’ consistency: digital rectal examination (DRE) as a screening test had sensitivities ranging from 0% to 50%, had consistently high false-positive and false-negative rates, and did not improve the predictive value of the other components of a typical trauma examination.
Based on case reports of five patients, the authors suggest DRE may be of value during trauma evaluation in the following settings: (1) patients with evidence of penetrating trauma in the vicinity of the rectum, (2) cases in which the presence of neurologic injury is neither completely supported nor refuted by the clinical ﬁndings, and (3) before pharmacologic paralysis. A selective approach is therefore recommended. Some good news for your patients if this will persuade you to discard another piece of longstanding dogma perpetuated in basic trauma teaching.
Should the digital rectal examination be a part of the trauma secondary survey?
Ann Emerg Med. 2009 Feb;53(2):208-12
In contrast to literature showing high intubation failure rates by ground paramedics, a review over eight years of 369 intubations by flight paramedics and nurses showed successful tracheal intubation in 92.1% cases. Of the 369 intubation encounters, rapid sequence medications were given in 345. The authors ascribe their success to both initial training and mandatory ongoing practice and demonstration of competencies.
Performance of endotracheal intubation and rescue techniques by emergency services personnel in an air medical service
Prehosp Emerg Care. 2009 Jan-Mar;13(1):44-9
This CT study of 110 trauma patients showed: ‘the standard 4.4-cm angiocatheter is likely to be unsuccessful in 50% (95% conﬁdence interval = 40.7–59.3%) of trauma patients on the basis of body habitus. In light of its low predicted success, the standard method for treatment of tension pneumothorax by prehospital personnel deserves further consideration’. Consistent with several other Ultrasound and CT-based studies published on the same subject then.
Needle thoracostomy for tension pneumothorax: failure predicted by chest computed tomography
Prehosp Emerg Care. 2009 Jan-Mar;13(1):14-7
No rescuer or bystander has ever been seriously harmed by receiving an inadvertent shock while in direct or indirect contact with a patient during deﬁbrillation. New evidence suggests that it might even be electrically safe for the rescuer to continue chest compressions during deﬁbrillation if self-adhesive deﬁbrillation electrodes are used and examination gloves are worn. This paper reviews the existing evidence, but warns more deﬁnite data are needed to make absolutely sure that there is no risk before deﬁbrillation safety recommendations are changed.
Is external defibrillation an electric threat for bystanders?
Resuscitation. 2009 Apr;80(4):395-401
Blood transfusion in trauma is a risk factor for acute respiratory distress syndrome (ARDS). An analysis of 14070 patients in a trauma database showed that 521 (4.6%) developed ARDS. Logisitc regression analysis demonstrated that, independent of injury type, injury severity, or pneumonia, (1) early PRBCs transfusion of more than 5 units during the ﬁrst 24 h of hospital admission predicted ARDS and (2) each unit of PRBCs transfused early after admission increased the risk of ARDS by 6%.
Early packed red blood cell transfusion and acute respiratory distress syndrome after trauma.
Anesthesiology. 2009 Feb;110(2):351-60
Bispectral index monitoring (BIS) was applied to 57 intubated patients transported by a Helcopter Emergency Medical Service (HEMS), demonstrating (1) that the patients were adequately sedated, (2) BIS works in helicopters, and (3) there is enormous scope for publishing work related to the retrieval environment – anything is of interest!
Bispectral index monitoring in helicopter emergency medical services patients
Prehosp Emerg Care. 2009 Apr-Jun;13(2):193-7
Further evidence from the UK shows that patients with acute traumatic brain injury suffer delays in the neurosurgical evacuation of intracranial haematomas which are increased from an average of 3.7 hours to 5.4 hours if they have to undergo interhospital transfer. Coordinated regional trauma systems please!
A prospective study of the time to evacuate acute subdural and extradural haematomas.
Anaesthesia. 2009 Mar;64(3):277-81
Paramedics intubated simulated patients positioned supine on the floor by direct laryngoscopy (DL) and by using the Airtraq device. Ventilation was achieved more quickly with the Airtraq in a difficult airway scenario (tongue oedema), and after a short training period the Airtraq was faster at intubating a ‘normal’ airway.
Comparison of use of the Airtraq with direct laryngoscopy by paramedics in the simulated airway.
Prehosp Emerg Care. 2009 Jan-Mar;13(1):75-80