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Neuromuscular blockers for prehospital intubation in traumatic brain injury▸
This study was carried out on all patients admitted to a level 1 trauma centre between January 1998 and June 2003. It has previously been shown that by using neuromuscular blocking agents (NMBAs) in the prehospital setting, the success rate for intubation is improved. However, some recent evidence suggests that the use of such agents worsens outcome in head injury. A trauma registry was used to identify patients who had a head Abbreviated Injury Scale score of 3 or more, and the records were matched with prehospital databases. Patient stratification using the prehospital Glasgow Coma Score (GCS) was also used and outcomes included mortality, with good outcome taken as survival to discharge with a GCS of 14/15. A total of 3052 patients were identified, and 2012 of these had complete prehospital data. The intubation rates were 17% for the mild head injuries, 58% for moderate head injuries, and 95% for severe cases. NMBAs were used in 72% of the patients intubated. The patients who received NMBAs before intubation were significantly less likely to be hypotensive or require cardiopulmonary resuscitation, and the unadjusted mortality for patients intubated with NMBAs was 25% compared with 37% intubated without NMBAs (p<0.001). Patients intubated with the use of NMBAs were significantly more likely to survive and have a good outcome, when adjusted for confounding variables. The results of this study may help to shape future prehospital care, but implications outside of the US are unclear given the very different systems currently in place.
Decision rule for knee x rays in children▸
The Ottawa Knee rule is widely used for the assessment of acute knee injuries in adults, but patients under 18 years of …