Nov 09 2022
EZ-IO for Epidural Hematoma? Drill This into Your Brain!
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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.
Aug 29 2022
The TBI SBP Sweet Spot – Is 130-180 mmHg the New Normotension?
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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.
Jan 21 2022
No LP if CT Negative Out to 24 Hours?
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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%.
Nov 23 2021
Does This Patient Have Cauda Equina?
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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.
Sep 14 2021
Fluid Balance in TBI – Don’t Drown the Brain
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In patients with TBI, aim for normovolemia. Positive fluid balance was associated with increased mortality and poorer neurological outcome.
Jul 19 2021
Is No Treatment an Option for Blunt Cerebrovascular Injury?
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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.
Jul 08 2021
Point | Counterpoint – No LP if Negative CT for SAH
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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.
Jul 07 2021
Point | Counterpoint – Do LP if Negative CT for SAH
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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.
Jun 16 2021
TREAT-CAD RCT – Aspirin or Warfarin for Cervical Arterial Dissection?
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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.
Jun 02 2021
EMS Predictors of Pediatric C-Spine Injury
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EMS assessment of blunt trauma found these variables were were associated with c-spine injury (CSI): axial load, altered mental status, signs of basilar skull fracture, substantial torso injury, substantial thoracic injury, respiratory distress, and decreased oxygen saturation. But these criteria need validation before using them in practice.