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Prehospital tracheal intubation in trauma ▸
In this Danish observational study conducted between 1998 and 2000, 74 severely injured patients underwent prehospital intubation. Of these, 84% (62/74) received anaesthetics. Twelve intubations were performed without anaesthesia. Fifty eight per cent (36 of 62) of patients who were given anaesthetics and 8% (1 of 12) of patients who were not given anaesthetics survived at least six months (p<0.05). The authors compare their results to previously published work from London that found 0.2% (1 of 486) survival among trauma patients who underwent prehospital tracheal intubation without anaesthesia or muscle relaxants. Although this Danish study was small, its comparatively higher (though still poor) survival in patients who underwent prehospital tracheal intubation without anaesthesia may be related to differences in the trauma systems of Denmark and the UK. In the UK, paramedics perform tracheal intubation without the use of anaesthetic drugs on trauma patients when the airway is compromised and basic airway manoeuvres have failed. In Denmark, ambulance crews do not intubate. Furthermore, (accident and) emergency medicine is not a separate specialty. Anaesthetists work in emergency care in and out of hospitals. Despite these differences in trauma systems, the prognosis of all trauma patients intubated without the use of drugs is poor in both systems and the value of this practice is questionable. Clearly, to be able to permit easy passage of a tracheal tube without anaesthetic drugs, a patient must be profoundly unconscious with a high likelihood of death.
Acute myocardial infarction may follow blunt chest trauma ▸
Rugby is regarded by some as somewhat dangerous, and this report may add fuel to the flames. It describes coronary artery dissection with resultant myocardial infarction in a 21 year old after blunt chest trauma in a tackle. Although initial electrocardiogram (ECG) and echocardiogram showed transient ST segment elevation and anterolateral hypokinesia, cardiac catheterisation reportedly showed normal coronary arteries. A diagnosis …