New Guidelines for Mild Pediatric TBI
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In this systematic review, authors identified clinical practice guideline (CPG) recommendations with moderate to high quality evidence that can be used by the ED practitioner to help in the care of pediatric patients with mild traumatic brain injury (mTBI).
Source
Clinical Practice Guideline Recommendations in Pediatric Mild Traumatic Brain Injury: A Systematic Review. Ann Emerg Med. 2023 Dec 22:S0196-0644(23)01381-1. doi: 10.1016/j.annemergmed.2023.11.012. Epub ahead of print.
Ketamine vs Etomidate in TBI – Prehospital Version
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Patients with TBI who were intubated in the prehospital setting had no difference in 30-day mortality when comparing induction with ketamine versus etomidate.
Source
Etomidate versus Ketamine as prehospital induction agent in patients with suspected severe traumatic brain injury. Anesthesiology. 2024. Jan 8. Doi: 10.1097/ALN.0000000000004894. Online ahead of print.
Cauda Equina Syndrome – Spoon-Feed Version
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Cauda equina syndrome (CES) is a spinal emergency. This is a practical guide for diagnosis and management as well as review of recent literature published on the topic.
New ACEP Clinical Policy on Mild TBI
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ACEP has issued an updated Clinical Policy to provide evidence-based guidelines for management of adult patients presenting to the ED with mild traumatic brain injury based on systematic review of available literature.
Source
Clinical Policy: Critical Issues in Management of Adult Patients Presenting to the Emergency Department with Mild Traumatic Brain Injury. Ann Emerg Med. 2023 May; 81(5): e63-e105. doi: 10.1016/j.annemergmed.2023.01.014.
This Is BIG – New AAST Brain Injury Guidelines
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This article was a multi-institutional prospective validation of the American Association for Surgery of Trauma (AAST) Brain Injury Guidelines (BIG), which were developed to guide effective resource utilization for traumatic brain injury. The validation study demonstrated that this system was accurate and safe and that its implementation can reduce CT scan utilization and neurosurgical consultation.
Source
Validating the Brain Injury Guidelines: Results of an American Association for the Surgery of Trauma prospective multi-institutional trial. J Trauma Acute Care Surg. 2022 Aug 1;93(2):157-165. doi: 10.1097/TA.0000000000003554. Epub 2022 Mar 28.
New AHA SAH Guidelines – Spoon-Feed Version
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Aneurysmal subarachnoid hemorrhage (aSAH) is a deadly condition. Here’s a quick summary of the 40-page AHA/ASA evidence-based guidelines for diagnosis and management.
CT C-Spine Negative? Clear The Kid’s Collar
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In this large, single-institution retrospective review of pediatric blunt trauma patients, no clinically significant injuries (requiring operative intervention) were missed when using multi-detector CT scan as the imaging modality of choice.
Does Ketamine Raise ICP in Children with TBI?
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This retrospective study of thirty-three pediatric patients with severe traumatic brain injury (sTBI) demonstrated no increase in intracranial pressure (ICP) after administration of ketamine.
Source
Acute Effects of Ketamine on Intracranial Pressure in Children with Severe Traumatic Brain Injury. Crit Care Med. 2023 Feb 24; e005806 DOI: 10.1097
SELECT2 RCT – Endovascular Thrombectomy for Large Ischemic Strokes
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Thrombectomy plus usual medical care in patients with a proximal large vessel occlusion (LVO), a large ischemic core, and last known well <24 hours from presentation improves functional outcomes compared to medical care alone.
Source
Trial of Endovascular Thrombectomy for Large Ischemic Strokes. N Engl J Med. 2023 Feb 10. doi: 10.1056/NEJMoa2214403. Online ahead of print.
Should Medics Clear C-Spine in the Field?
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In this large, single-center prospective cohort implementation study, paramedics were able to apply a modified Canadian C-spine rule to assess low risk trauma patients and transport a large proportion of them to a higher level of care without spinal precautions.