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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.
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The EZ-IO may be considered as a temporizing measure for trepanation of an epidural hematoma (EDH) in rural ED settings. This should be considered only under the guidance of a skilled neurosurgeon when immediate transportation to a higher level of care is not possible.
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In-hospital mortality of TBI patients decreased linearly as the lowest observed out-of-hospital systolic blood pressure increased, with the lowest mortality between 130 and 180 mmHg.
Source
Optimal Out-of-Hospital Blood Pressure in Major Traumatic Brain Injury: A Challenge to the Current Understanding of Hypotension. Ann Emerg Med. 2022 Jul;80(1):46-59. doi: 10.1016/j.annemergmed.2022.01.045. Epub 2022 Mar 24.
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When using multislice CT (MSCT) scanners this study suggests it may be possible to extend the timeframe from headache onset within which aneurysmal subarachnoid hemorrhage (aSAH) can be effectively ruled out with imaging alone. They found that when MSCT was employed within 24 hours of symptom onset, the sensitivity of detecting aSAH remained 100%.
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This retrospective review demonstrated that bilateral lower extremity pain, sensory loss in a dermatomal distribution, and loss of bilateral ankle or knee reflexes were the best correlates to a radiographic diagnosis of CEC (cauda equina compression). Also, rectal exam had little to no diagnostic utility.
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In patients with TBI, aim for normovolemia. Positive fluid balance was associated with increased mortality and poorer neurological outcome.
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Treatment with antithrombotic therapy was associated with decreased risk of death and stroke in patients with blunt cerebrovascular injury regardless of vascular injury grade.
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The prevalence of subarachnoid hemorrhage (SAH) for patients presenting with sudden onset headache after a negative head CT is less than 1%, and the time, resources, and risks associated with lumbar puncture (LP) are not insignificant. Therefore, LP may not routinely be needed to rule out SAH after a negative head CT, even if the scan is performed more than 6 hours from symptom onset.
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In patients who are deemed “High Risk” for a subarachnoid hemorrhage (SAH), and present > 6 hours after symptom onset, a negative head CT must be accompanied by a lumbar puncture to satisfactorily rule out SAH.
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Aspirin was not non-inferior to vitamin K antagonists in reducing bad clinical and MRI outcomes at 14 days in adult patients with cervical arterial dissection.
